I have decided to start a "blog" journal after stewing an idea for many months. The idea is that I would actually do something about an issue that I feel strongly about. That issue is patient safety.
Patient safety was the main reason that I left clinical medicine. I couldn't deal with the daily stress of seeing an excessive number of patients, of insurers pushing patients out of the hospital before they are ready to be discharged, of the healthcare system denying patients of the kind of care that I would want for myself and my familiy, of nursing homes understaffing techs and allowing patients to fall out of bed or not be fed, of emergency rooms delaying diagnoses and treatment due to overcrowding, of drug companies raising profit margins by making prescription drugs prohibitively expensive, of administrators and doctors treating low-income, ethnic, non-English speaking patients as low threat on the malpractice liability radar, of medical schools still painting a rosy picture of a profession of altruism without regards for the real practice enviornment (thereby perpetuating ignorance and complacency). Even now, after I have left clinical medicine, I hear almost weekly, reports of preventable medical "errors."
Just yesterday, an ex-colleague told me that she had quit working for the BIG HMO (for those interested, the HMO has the initial, well, I can't say, but it's the most well known in the country). One night, she was on service, a patient ruptured his abdominal aneurysm. There was no CT/vascular surgery service at the hospital, and the doctor could not get the HMO to transfer the patient to a hospital where there was one. After 8 hours of telephone effort, trying to arrange for the transfer, my friend the doctor, got no where. The patient got no care. Then, in an act of desperation, my friend the doctor, literally called the HMO hotline and demanded to talk to the President of the HMO. Yes, she called the President of the HOM at 10PM at his home. It took a call like that to get the patient transferred to the appropriate facility. My friend the doctor is a MOMMD, with two little children at home. She didn't get home that night until midnight. She had to neglect her other patients, her family, and herself, so she could work through 8 hours of dealing with the HMO. Stories like this make me mad. Especially when I see the glossy and creative commercials that this HMO puts on TV.
A colleauge of mine had to testify in court against some ICU doctors she used to work with. The case is a 3 year old girl who came into the hospital, in coma, with an ammonium level of 188. At 10PM, my friend, the pediatric neurologist, came into the hospital to see the girl, and made the diagnosis of urea cycle enzyme deficiency, a rare medical condition. Over night, the girl's ammonium level climbed to the 200's, and then higher and higher, until it reached over 1000. The girl died the next morning. The plaintiff argues that the pediatric intensivist should have treated the girl with dialysis. But, I know from firsthand experience the reality of medicine. Given the pressure not to call consultants, the pressure not to draw labs, the pressure not to mobilize other services in the middle of the night, the pressure of having to care for 20-30 other ICU patients, all in the situation of treating an obscure medical entity, I could understand from the intensivist's perspective of how this case could have happened. It really isn't a single person's fault. You cannot point fingers at the doctor: the doctor is only a small component of the healthcare milieu that he worked in. So do you sue the insurance industry? Do you sue the government? Do you sue the medical education for not ensuring that every pediatrician knows about urea cycle deficiency? Why should the doctor be burdened with this all by himself? But, I also understand the anger and the anguish of the father felt by the dead girl.
Simultaneously, another doctor friend told me that his surgical colleagues are all waiting nervously to see if Viriginia will keep its malptractice award cap. The surgeons are anticipating that if the cap is gone, there would be an exodus of high-risk surgical specialty doctors leaving the state.
But is putting a cap on malpractice awards a solution that addresses the fundamental ills of our health care system? No.
Never have been a "political activist" in my life, and having had zero experience in "fighting for a cause," I am embarking on a journey. The journey is to see if I could channel some of this frustration into a productive cause. SAHMD posted this article a while back:
I've read the article several times now, and each time I read it, I become more convinced that this is a great idea to try.
So here's my plan. After the holiday season, I will call the Clinton/Obama congressional offices in the Senate, and see if I could become a volunteer staff for their campaign to put this bill on the Senate floor. Being in Washington DC, the location couldn't be better.
This blog will illustrate my journey into that unknown world where medicine, politics, law business, and public interest intersect. A world which I know nothing about. I am thinking of volunteering for about 20 hours a month. It's ironic that it is my NON-clinical job in the federal government that gives me the "free" time to do things like this, by way of "professional development." So all the chips have fallen into places, and the time is now. You know how sometimes in your life, everything is aligned, and there's almost a sign that says, "Go."