Eating in the hospital

There aren't too many options for eating when you're working 10-12 hours a day and rushing around all day. To be honest, especially at the beginning, when I'm carrying a lot of patients, I'm so involved and busy I think my adrenaline is going all day, and I don't have much of an appetite! Even when we're at a meeting and there's food in front of me, sometimes I don't feel like eating. If you know me, you know that's unheard of - first of all, I usually have a huge huge appetite. Secondly, if there's free food, I'm there. But I power through - I make myself eat. :)

Even when there's time, and I'm hungry, one of the problems is that the only option we have is the cafeteria. Sure, you can order in or have something delivered, or take a quick 5-10 minute walk to somewhere to get some food, but all that takes more time and also costs more. The issue really is that it takes more time and that it's difficult to leave. You really have to be in the hospital at all times in case something happens to one of your patients, or to answer pages or put orders into the computer. I guess people can also bring food, but that's rare - you hardly have energy to make dinner for yourself after coming home from a 12-hour shift, much less lunch for the next day. A few people with significant others sometimes can do it. And you can do it sporadically, but it's far from common. So you are really limited to the cafeteria, and sometimes you don't even have time to go the cafeteria!

Even when you're able to make it to the cafeteria, the selections are horrible, limited, and repetitive. And the cafeteria closes down around 7:45pm, so if you are working a late shift, you have to make sure to get in early for dinner. For lunch, we don't have 5-10 minutes to wait for hot entrees to be made often (like cheesesteaks or grilled cheese sandwiches), so we often go for the quick already-prepared foods. Soup is always a good option, and inexpensive, but they go through the same soups every week so those get a little tiring. Sushi is also a good option (although it's not like it's great sushi), but it's expensive. The salad bar is actually pretty good, but it's not cheap and you can't eat salad everyday either. The hot entrees are also not cheap, are often terrible, but are very fast items to get besides soup and sushi. Other fast options include ready-made sandwiches (horrible), burgers, fries and onion rings, chicken wings, mozzarella sticks, and some other fried foods. The options are even more limited for dinner. Because of all these things, doctors usually end up eating horribly if they eat at all. There's a joke that doctor's are the least healthy people in the hospital.

It'll be nice when I can cook more again.

A good blog

This is a great blog:

Stuff white people like

ha

Look at this site about what a proctologist is... more specifically, look at the girl they put on there! That's a proctologist? Ha. Or you might get they funny looking guy with the stare. Interesting way of depicting proctologists. :)

A lesson well-learned

The call system for Pennsylvania Hospital is a little different from other hospitals. I won't go into it now, but suffice it to say there are three types of calls - short call, medium call, and long call. Over the last 3 weeks, on medium call, I've generally been able to get out at 6 or 6:30. So I thought yesterday would be no different. In fact, we had already bought tickets to go to a large music festival with the rest of our friends. The plan was for me to get out, Pete would pick me up, and we would go directly there to join everyone around 6:30 or 7. It was a pretty crazy day and I picked up the max number of patients I could possibly pick up (which has been the case for the last 6 calls I've been on), and there were some complications with other patients. I didn't get out of the hospital until close to 8:30pm, at which point, not only was I exhausted, but I hadn't eaten, and we would only get to enjoy about an hour of the music festival by the time we got there. So I just went home.

The moral of the story? Don't buy tickets, especially expensive ones, ahead of time unless you are sure that you will get out in time.

Medicare sucks

There are a lot of changes going on in health care. One is that pretty soon in Pennsylvania, it will be mandatory for hospitals to report hospital-related infections. Now, I believe this is a very good step overall. For one, it's important for hospitals to keep track of something like that, and to take steps to lower the numbers. It is probably impossible to completely eliminate it, but it's crucial to reduce it as much as possible. Although hospitals should already be taking measures to do so, I think mandatory reporting will go a long ways toward speeding hospitals along. Secondly, I think it's good that patients will be able to access this information and see the rates of hospital-related infections at different institutions. This may help them make health care decisions, which in turn, will pressure these institutions to lower their rates of hospital-related infections.

However, I also see some potential problems. For one, I have heard that Medicare is going to stop paying for hospital-related complications and infections. Now while I believe that many hospitals will be able to reduce these by quite a lot, hospital-related infections will never be completely eliminated. Let me give an example.

A patient comes in because he had a heart attack. He's on the older side, also has hypertension, and congestive heart failure. The heart attack really does a number on his heart and it starts failing. He can't pump his blood well, fluid builds up in his lungs, he can't breathe, and he gets sent to the ICU and gets intubated - that's getting a tube thrust down your pharynx so that you can breathe with the help of a machine. This is a life-saving intervention. Without it, this patient would have died. However, several days after intubation, the patient develops a rip-roaring pneumonia. He gets treated with antibiotics and gets better. Eventually, the patient's heart gets better, he gets extubated (the breathing machine is removed), has open-heart surgery and lives another happy 20 years.

A relatively high percentage of patients that are intubated develop pneumonia. While this is serious, it can be treated with antibiotics. Medicare is saying that they will not pay for the antibiotics, because this type of pneumonia is a hospital-related infection - even though this infection was the result of a life-saving intervention! This is not the only example of something like this - there are many others.

Who is going to pay for the cost then? The patients? No - they never have enough money. So it will go to the hospitals. They will have to eat the costs and make up for them by billing more for just about everything else. Would it be ethically okay for the hospital and doctors and nurses to say, well, this patient will probably develop pneumonia if we intubate him, and we won't get paid for that, so nevermind. Let's just let him die. Of course that would not be ethically acceptable, and of course that won't happen.

I think it's ridiculous and sustainable for neither the insurance companies nor the hospitals.

Paul Levy, the president and CEO of Beth Israel Hospital in Boston posted about this topic and I think he also brought up some very good issues.

The neverending bag of patients

I have had a lot of patients on my list everyday - nearly the max an intern can carry. Today I discharged four patients. That's a lot. But it didn't matter - I admitted another four in the afternoon into night, and there will probably be another one I get there in the morning.

Sigh.