What Are We DOing?
Recently I had a patient encounter go differently than the way I wanted. The patient is fine now, and it was not the fault of myself or the patient or her parents. Rather the problem was with the physicians, and more specifically, the protocols of the health systems they work for. In short, the patient had an abnormal exam, abnormal vitals, and diagnostic studies that I had done in the office that all supported the suspected (and later confirmed) serious diagnosis and just how sick she was. It was clear to me that she needed admission to the hospital quickly. It was even clear to the physicians at the two health systems that I called to try to get her admitted that that was the level of care she needed based on the labs alone. But because they couldn’t see this information in their EMR system, they declined to admit her directly and instead directed that she should go to the local ER even though they would immediately transfer her once she was stabilized, which I had already ensured she was. The reasoning: that’s how we do things. And so, the patient sat in the local ER waiting room for nearly three hours before being seen and then quickly being transferred to a higher level of care facility. A direct admission by either of these facilities would have had her receiving care within an hour.