I drive a fast car, which, if you know me, is quite uncharacteristic. I would say that it is one of the few possessions that generally doesn’t reflect who I am. How I chose this car—the make and model—are a long story not to be discussed here. But let’s just say that it has quite a kick.
These thoughts jostled through my mind this morning as I pulled into the hospital parking lot. A recent momentous decision, I had surrendered my privileges at this hospital and started using the hospitalists. It had all become too hard: the inane compliance issues with the new electronic medical records; the emergency department attendings admitting my patients without calling me; and the slew of protocols, documents, and attestations at this institution were becoming particularly onerous. The administration was pushing out the primary care physicians with the indignation of a million not-so-subtle pinpricks.
I was making a courtesy visit. I had asked the emergency department physician to have the hospitalist call me the night before. I have known this patient exceedingly well over the years, and had a good impression of what had happened. I was unable to relay this information, however, because I never got a phone call.
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I didn’t agree with the diagnosis or treatment plan, but the admitting hospitalist was no longer available and the nursing staff had no idea who to call. I carefully documented my knowledge of the patient’s medical history, examination, and my thoughts in a progress note. I also left my mobile number and begged the rounding physician to call me. I am not hopeful. Eventually, after much searching and paging, I will likely reach the physician by the end of the day. Que sera, sera.
This hospital is in the midst of a major rebuild, and part of the process is a new entrance to the expressway adjacent to the parking lot. The beauty of this new pathway is that following a few careening turns, the entrance ramp is a straight shot for a few hundred feet.
This morning, I came to a full stop after those turns, and waited for the cars on the expressway to pass at 60 mph. I put all 4 windows down and put the pedal to the metal.
At 10, 30, 50, and 70 mph, I sped past all the cars ahead of me. The wind blowing into the car and smacking me in the face. Power, speed, freedom, joy!
Eventually, I merged left and began the process of applying the brakes. I was coming up quickly on a series of cars driving at more conventional speeds.
The fun is over—it couldn’t last forever.
It seems it’s no longer our patients that we answer to.
Because I’ve been told, in no uncertain terms, it’s time to stop bucking the system.
And get back into my appointed lane.
