Not Quite The News

I have a love-hate relationship with the media. I love it in the sense that I have an addiction to information. I want to know what's going on. I read newspapers, watch the news on TV and listen to it on my car radio during my endless commute. I hate it when it comes to medical news. It is usually sensationalist and can pretty much be counted on to distort whatever new study has been deemed 'newsworthy' by some guy in an editing booth. It's frustrating.

And today is no exception. This news article describes the story of a woman who died after spending 3 days under observation in the hospital. The article goes on to describe the concept of the 'orphaned patient', and goes on to blame the fact that the doctors who take responsibility for orphaned patients have a maximum quota of 5 patients per day. Then Kevin, MD jumps on the bandwagon by posting the link to the article with his parting shot... "no wonder there's an access shortage up there".

Please. The issue of orphaned patients in GP-run hospitals is a little more complex than that. A bit of background for the lay-folk-- in many community hospitals, when patients are admitted it's their family doctor who assumes responsibility for their day-to-day care. If a patient is admitted who doesn't have a family doctor (or whose family doctor doesn't have privileges at the hospital admitting the patient) the patient is assigned a family doctor-- either a family doctor who takes on the care of these 'orphaned' patients, or a hospitalist, whose sole job is to manage the care of a large number of orphaned inpatients.

Family doctors have it tough when it comes to the care of inpatients in the hospital. It doesn't pay terribly well, and it's a difficult responsibility to balance with a full day of office. At my practice, a typical day has me coming in at 8am to begin rounding in the hospital. If I know we have more than 3-4 patients in at any time I'll come in earlier. If we had the misfortune of getting hit with an orphaned patient overnight, I was often faced with rounding on our inpatients as well as sorting out an often complex medical history and medication list for a patient I've never laid eyes on before. No easy task. One orphaned patient admission could easily take 45 minutes. Add that to the usual rota of patients in the hospital at any given time and rounding in the morning could stretch to 2 hours, starting the day's clinic 45-60 minutes late.

Last year our call group made the decision to stop accepting the assignment of orphaned patients. The workload had become unreasonable, and was only getting bigger as more physicians removed themselves from orphaned patient coverage. The hospital kept promising to hire hospitalists to help shoulder the load but none were forthcoming. So our group bailed.

Caring for inpatients means more than just stopping by to say hello on the way to clinic every morning. The five patient quota would still be a full house when you consider the time to round, write orders, put out fires, liaise with specialists and field phone calls throughout the day relating to the usual odds and ends that come up. And this is on top of the full day's office, minor procedures, house calls and paperwork that fill the typical family doctor's day.

Who is the Ottawa Sun (or Kevin MD, for that matter) to suggest that family doctors who limit their 'quota' to five patients are somehow slacking and shirking their responsibility to the health care system? Would it somehow be better for family doctors to double their inpatient quotas and cut their office hours in half? Family doctors are already putting in 12 hour days on any given workday-- something has to give.