Physicians have to stay in their lanes

I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn’t reflect upon 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 surrendered my privileges at this hospital and started using the hospitalists. It had all become too hard. The inane compliance issues with the new EMR. The ER attendings admitting my patients without calling me. The slew of protocols, documents, and attestations at this institution recently became particularly onerous. The administration was pushing out the primary physicians with the indignation of a million not so subtle pinpricks.

I was making a courtesy visit. I had asked the emergency room physician to have the hospitalist call me the night before. I knew 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.

I didn’t agree with the diagnosis or treatment plan. The admitting hospitalist was no longer available, and the nursing staff had no idea who to call. I carefully documented my knowledge of the patients past medical history, exam, 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 four windows down. Then I put the pedal to the metal.

10, 30, 50, 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.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.