Yesterday RK was in the emergency room at Montefiore with a hip fracture. Every call I made to the hospital or specific doctor was to talk about her. Every call they made to me was to ask about paperwork or scheduling. The most revealing was that I called the orthopedic surgeon who operated on her before to request his consult. He or his team then bypassed me and called the geriatrics division to do a preoperative assessment, commonly called clearance on RK who they didnt know. The mind set was gotta get the paperwork done before surgery. I called the geriatrician and asked, How can you do preoperative clearance on a patient you dont know without talking to me, and he said, I have the records from the last hospitalization. I said, that was three years ago. A lot has happened. How do you know what to do with her steroids? How do you know what antibiotics she last received? Or the changes we made to her oxygen. Its not her responsibility to tell you these things. The attitude was that his job was to do the paperwork as if thats what makes surgery without complications. If she had had a complication, technically there was no mistake. Preoperative clearance is not the doing the paperwork. The job of the geriatrician is actually to reduce the risk of preoperative, intraoperative and postoperative complications including death. Thats not possible without knowing past and recent events in the health of a complicated old person. Attitude, knowledge, then skills.
Posted on: Mon, 06 Oct 2014 22:54:12 +0000
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