Wednesday, March 30, 2011

Crush of the week.

I have a new one, which is always a good thing, because it means people are stepping up to the task at hand in a big way.

My hospital, recently, lost it's heart surgeons. We had two cardio-thoracic-vascular surgeons (both of them really good) up and decamp to another hospital. They left for lots of reasons, major dinero being first and foremost. Anyway, after a nation-wide search, we have, as of the beginning of the year, two new surgeons. Now, we just had to deal with the vascular butcher last summer -- the doc (lower case) who caused complete mayhem. Understandably, all of us, from the CVOR, to SICU, to CVTU, were apprehensive. Well, maybe a little more than that. Our ARNP was feeling out of the loop. The anxiety in the staff was palpable.

January, 2011. Dr D has assumed CVT responsibility, all of it. Dr W is out of the game for a bit, because he broke one of his fingers. Everyone knows the story behind it, and it endears him to us all. Sight unseen. It is that kind of story. Dr D makes a point of rounding and meeting all the nurses -- all million of us. It has got to be overwhelming, but he is gracious, and seems kind, calm and caring. And he talks, really talks, to his patients. That is huge. It doesn't hurt that when he writes orders his last is always, "Thank you kindly". He is the kind of Doc that nurses will go the extra, extra mile for. That doesn't happen often.

But, my crush of the week goes to Dr W. He actually told an under 50 year old, 2 pack a day smoker, 12-pack+ a day drinker that he wasn't going to operate on the patient's heart. The blockages weren't critical, and maybe lifestyle modification was in order. He re-consulted cardiology for medical management. CRUSH.OF.THE.WEEK. You don't take your meds (all of which, but plavix, on the $4 pharmacy list) but you continue to smoke and excessively drink, and you end up with yet another heart attack. Bypass is your last option. It takes a strong, confident doc to put the patient's problems back on the patient. Lifestyle modification. Hard to do, but necessary for the future in successful heart bypass. The message: We will fix you, but you have to invest in yourself first. Do your homework and we will do our part.

One instance of our tax dollars not being mis-spent.

Crush of the week. (and Dr W calls me by name, so he gets extra points.) I thought our CVTU program was going to take a major hit. I was wrong. We had a very small speed bump. I expect great things going forward.

And, because this is first and foremost a running blog: I ran 5 miles yesterday and 4 miles today. First runs since I decided to move to a new house. It isn't much, but it counts. I am sore, but my knee isn't complaining. I have DWD to get ready for and a Monkey to run. I take the little bits where I can get them.

Monday, March 21, 2011

I have a Crush

I have a friend on a running site who designated the "Crush of the Week". I now have one. Dr D., a hospitalist of the female persuasion, internal medicine on-call. Crush. Of. The. Week. (Maybe the MONTH. Or longer. It depends on who else steps up.)

Malingering. It means what it says. Docs shy away from saying it, because our society is so stupidly litigious. Nurses, not so much. Nurses don't get sued so easily, therefore we can call a spade a spade. We see patients all the time who love being sick for sake of being sick. Some people just like being in the hospital. They love the attention, and can go on forever about all their ailments, real or perceived. They know the buzzwords, they know the system, they take real dollars and real health-care away from people who really need those services.

I had a patient that no one would get rid of. NOTHING was wrong with this man, outside of his normal state of health. He just kept saying the right words, therefore the docs kept working him up for things that weren't wrong with him. Malingering. Walking the halls, hounding the nurses, being inappropriate with other patients, taking advantage of the nursing assistants. Everyone knew that he was fine, but no doc would stand up to him. Lawsuits, you know. Malpractice -- the driving force behind healthcare.

Anyway, Dr. D walks in and discharges the guy (with no narcotics). 8 hours later, after much drama (yelling, crying, wailing, begging, berating) he finally leaves. We send out surveys so that patients can tell us how good of a job they think we did. I don't think that Dr. D will fare very well.

Crush. Of. The. Week.