From: pamela wible <roxywible@comcast

From: pamela wible <roxywible@comcast.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Sat, 6 May 2006 23:43:25 -0700
Subject: Re: [Practiceimprovement1] 24/7 access, INPATIENT work and sanity
Reply-To: Practiceimprovement1@yahoogroups.com

This is an interesting topic and not one that has previously been discussed. I am in a solo LOVE model and I provide 24/7 access by phone. I see patients MWF afternoons and evenings. I am willing to go in other times, but have only had to do that twice in 13 months. People are ecstatic about my accessibility. Regarding inpatient care: Inpatient is not my favorite so I originally thought I'd pass that burden to some other doc in town who likes it better than I do (and there are many I could pass it to) BUT when I realized I would LOVE my job and not consider it a burden then I reconsidered the idea of doing inpatient work before I opened and I decided I would enjoy it if it was not a burden.

It has been really fun! I am ALWAYS AVAILABLE for my patients and I have no call group. It is not a burden. I am rarely called after hours. I have had 3 admits and 1 short stay (<24 hr) admit in 13 months. I have really found it stimulating to practice the LOVE model as it interfaces with the hospital. I think our style of practice really shines through as superb when we interface with the hospital. Most of us otherwise would provide superb care in our corner of the world without interfacing much with the larger medical system.

Here are some things I found incredibly fun about doing inpatient with the LOVE model:

1) My first patent was a young man with renal artery stenosis. I went with him for his procedure - angioplasty - it was amazing to watch. I think of all the times I sent folks for procedures that I have never had the pleasure (or TIME) to participate in and it make me sad. I spent time with the interventional radiologist, the patient and his family. I was in awe of our technology. I never had TIME to be in awe of our technology or have the pleasure to see patients through their interesting procedures. I was glad I went. Amazingly the interventional radiologist never went to talk to the patient after the procedure. I think it is unbelievable that he would not want to share in the joy of saving this young man's life. His BP went from 220/120 to 118/74. I shared in the joy of the procedure and the joy in saving this young man's life.

2) Another gentleman went in with COPD. He also has a huge lifelong anxiety issue. The pulmonologist actually told this man in a brief encounter in the hospital that he would not sell him 5 years of life insurance. The patient went into a panic stricken state. Luckily I was able to calm him and speak to him optimistically about his potential. How do scare tactics promote healing??? This patient is eternally grateful and raves about me to everyone. He did quit smoking for 2 months, but relapsed. We are working on it again.

3) Another pt called me and she likely had pneumonia and dehydration. I was at my stained glass class so I sent her to the ED. When my class was over I rode my bike over to the ED on my was home that evening just to see how she was doing and to fill in the ED doc on her issues. The doctor, the staff and nurses were *AMAZED* that I came without even being called!!! They went on and on about how they couldn't believe I just wanted to stop by. I spent 30 minutes there and then went home.

When patient relationships and not burdensome taking care of them is a pleasure and an honor. I wish more doctors could experience patient care in this manner.

BOTTOM LINE: Hospital systems are so large,complex, often fragmented and dysfunctional especially in the realm of communication and the pt/phys relationship. To leave our patients to fend for themselves when disempowered, weak and ill is not in their best interest. This is when they need us most. This is where we really show our true colors. I would not miss it for the world. And this is coming from someone who HATED inpatient. I LOVE it now!!!

It is our chance to really show the larger system who we are and why we are the wave of the future. I see it as part of the resurgence of the nostalgic "old fashioned" sacred physician patient relationship. Try it again. I highly recommend it.

Pamela