Not a Saint Hospital

One morning I found a note on my desk from my secretary. It said:

The Medical Director at St X would like an appointment with you to check that everything is going well for you at St X.

It wasn’t unusual to get a ‘summon’ from the Medical Director of these private hospitals. Usually, it is a low-key chat to make sure that the private surgeons working there are not having issues with the operating theatre equipment or staff, and that they have no complaints about ward care of their patients. It was just over 2 years since I have started bringing patients into St X for my surgical lists so I was expecting an invitation from the MD sooner or later.

I asked my secretary to shorten my next St X operating list, and arrange an appointment with the MD afterwards around 5pm for me.

This was the conversation:

MD: Hi Dr T, thanks for taking the time to see us. So, how’s everything going?

Me: Great. I have had no problems, the theatres are great, the nurses on the ward are helpful, my patients have had no complaints. They are liking the private rooms and….

MD: (Nodding vigorously and leaning forward to cut me off). Well, I want to talk to you about Mrs Y.

Me: Oh? Is she causing problems with the staff?

Mrs Y was a patient of mine on the surgical ward whom I had just admitted two weeks ago. She was a teacher in her late 50’s who sustained severe spinal injuries when she was a teenager and is now wheelchair bound. Mrs Y was also a long term insulin dependent diabetic who unfortunately had severe ketoacidosis last year and ended up in ICU, ventilated for 2 months. During her illness, they didn’t look after her pressure areas so she ended up with severe grade IV pressure sores over both the ischium and sacrum by the time she was transferred out of ICU. She was then discharged from hospital with this problem as no one wanted to deal with it whilst she was an inpatient. Mrs Y went back to teaching, and spent hours every day in her chair. When her blood sugars started to deteriorate and her family doctor noticed an unpleasant smell during one of her visits, it led to the discovery of her persistent pressure sores. By the time she came into my office, she was hyperglycaemic, septic with infection as both pressure sores were wide and deep enough for me to put two fists in each. I could see her ischial bone at the base of one, and the rectum at the base of the other, and because she was incontinent from her spinal injury, the wounds were severely contaminated with faeces as she sat in the wheelchair in her soiled diapers. Understandably, both her and her husband were by now, agitated and frustrated with unhelpful medical staff and hospitals.

I admitted her into St X, because it was a large tertiary private hospital with all specialties on hand. She required an urgent endocrinology review, infectious disease input, a general surgical procedure to divert her faecal output via a temporary colostomy, dressings and pressure care. Needless to say, she started to improve within 7 days. She required intensive nursing care with four times a day dressing change (to prevent accumulation of pus that was continually exudating from the wound) and two hourly turns to prevent development of new pressure sores while she was bed bound.

Mrs Y, at the beginning of the week, cranky from feeling ill and hating being bed bound, was not the best compliant patient. She was a teacher after all and did not like being told what to do. She was also a little distrustful of the nursing staff as it was poor nursing care in ICU which resulted in her current problems. However, after seeing herself improve over a week, she became the most pleasant and grateful patient on the ward. She helped the staff by setting an alarm clock and turning herself so that all the nurses had to do was to pop their heads into her room and check that she was in a different position. She also changed her own colostomy bags so that the staff didn’t have to deal with this particularly unpleasant job. The nurses told me that they enjoyed looking after Mrs Y.

I was rather surprised that the MD had brought her up in our meeting.

MD: No no, nothing like that at all. (He cleared his throat awkwardly). Patients like Mrs Y, well, we find it hard to accommodate them in this hospital.

Me: I know, I know, spinal patients should really be in dedicated spinal units, but there are no private spinal facilities for these patients. Mrs Y has been paying her private health insurance for over 30 years, so she didn’t want to go to a public hospital; she wanted to be looked after in a private hospital.

MD: We understand that, but private health funds in general don’t pay us very much for looking after patients like her. She requires intensive nursing care so we actually don’t get any profit for such a heavy nursing load.

Me: (Speechless for a second) So, let me get this right. You don’t want patients like Mrs Y because her admission doesn’t generate enough profit for the hospital?

MD: I just wanted to make you aware of this, so that you will remember in the future not to bring patients like her into our hospital. We would prefer day surgery patients, but if you feel strongly about keeping them overnight, we are more than happy to accommodate that. As for Mrs Y, I believe you are planning to keep her in hospital for a while?

Me: Yes. At least 3 months.

Both Mrs Y and I had a long discussion about this. She had agreed to take a whole semester out of teaching and come into hospital to have her sores treated properly. This meant bed rest with appropriate pressure care, no sitting in her wheelchair and regular dressings. I had explained to her in depth that if we could make her overall health better, these sores may heal without intervention. If not, they may need an operation. However, even with an operation, she will need to be off the surgical wounds for 6 weeks before she could sit on them. She knew she was in for the long haul, because she didn’t just bring her suitcase when she checked into the hospital, she also brought her Nespresso machine. According to Mrs Y, 3 months was a long time to go without good coffee.

I watched the MD’s face cringe.

Me: I can’t rush the healing process, and I have to wait for the infection to settle.

MD: Maybe you can find a little operation for her so that we can get a little more money out of her health fund during her stay?

Me: But she doesn’t need an operation. She just needs dressings.

MD: We are probably going to lose money if she stays that long.

Me: Would you like me to transfer her to the public hospital? (The MD looked up at me with surprise and a glint of hope in his eyes). I could just say to Mrs Y that St X doesn’t want you here because they are unable to make a profit out of your stay. They think you should really be in a public hospital despite the fact you have paid your private health premiums for the last 30 years…..

MD: No, no. (He started to clear his throat again). There is no need for that. I suppose since we are a hospital affiliated with the church, we can show charity by letting her stay her for a while.

Me: Righto. Is that all? (I started to get up to leave).

MD: But, (he stopped me turning towards the door), if you do a few more of your cosmetic cases here at St X’s, it may compensate for her stay.

He stood up and reached out to shake my hand.

Me: Well, I cancelled two breast augmentations this afternoon because of this meeting. I have transferred them to my lists at another hospital tomorrow.

I ignored his hand, turned to open the door, and walked out of his office without a backward glance.

Mrs Y stayed for the full 3 months and went back to teaching full time, sitting in her wheelchair with a beautifully healed bottom.

 

62 thoughts on “Not a Saint Hospital

    • OMG! That is beyond disgusting! Do these bean counters have no sense that the practice of medicine is more than just making money off sick people? Good for you for answering him in a way that should have made him squirm. Even better was the movement of the money making patients to another hospital and allowing this very sick woman to stay for 3 months without any unnecessary surgical procedures. Bravo to you for being a good doctor!

      • I was so furious I did think about leaking it to the media but there would have been collateral damage – unfair to with patient and staff confidentiality. I liked the staff that worked in the hospital, despite the a-hole director! It wasn’t hard doing the right thing! Thanks again for reading my posts 🙂

  1. Sadly, this is case at all “corporate” hospitals everywhere. It’s purely business. And admin usually consists of extremely bottom- line conscious, B- schools grads who have no idea what patient- care means or how much we invest in each patient. Patients are usually charged for drugs that are never used on them or for them in the OR- to add to the stock, I was told once. Poor things have no idea of course, unconscious and vulnerable on the table- trusting us completely….

    • I know, I was going to ask him how would he feel if it was his mother with spinal injury and pressure sores in hospital…. Would he take her to a public hospital?!?! But then I have learnt people get defensive when it becomes personal.

  2. High Five for Dr. T 🙂 Imagine the Church-based hospital’s values coming to the rescue at the last minute, for shame! It takes courage and energy to advocate for others and stand our ground. Let’s hope the nitwits running these corporates don’t grind the rest of humanity down in the chase for the next shareholders’ pay out.

  3. What, no pictures of gaping open wounds?

    Out for profit?! Christ, you guys are sounding more and more like America every day. The unflattering side.

    Ketoacidosis sent me scurrying to the dictionary. Is that the sort of thing that’s going to happen on a regular basis here? It’s best we get that out into the open straight away.

    Doctoring sounds kind of gross. May I DO want to hear about your materialistic side after all.

    Goodness gracious, you’re a good writer.

    • Hahaha Mark, you crack me up! Sorry to expose you to the unpleasant side of medicine 🙂 but then, you did expose me to urinal art which is pretty gross itself! 😀
      And thank you, kind sir, for your compliment. I love telling my stories and hope to convey it as I see it, warts and all!

  4. Wow. Horribly disgraceful. Health care isn’t perfect by any means, but that is completely unacceptable. Good on you for doing the right thing!

  5. Yes! You sound like you have a “Take no Prisoners” when administration forgets about the patient- Awesome! Reposting this on my blog so fellow nurses can see what you all go through.

  6. Pingback: A Surgeon That Doesn’t Mess Around | Don't Curse the Nurse!

  7. May I say, Beautifully Done, You!!! What nerve, especially from a church-related hosp; though I’m fully aware that church-related anythings are just as prone to human flaws and weaknesses as any other institutions and individuals, it’s just that when they pretend to aspire to higher things it rankles me particularly that they so often fail so spectacularly to meet those aspirations. Meanwhile, Mrs. Y. is beyond lucky to not only have a savvy, skilled surgeon who knows the differences between various options for healthcare in their efficacy and humaneness but is willing to advocate for patients in such an intelligent and firm way. I would hope for such excellent support from any of my own healthcare team at any time!

    xo,
    Kathryn

  8. Last time I checked, to be MD you had to be a physician. Did he forget his oath or was it surgically removed upon promotion? Perhaps it’s the Peter Principal in effect.

    Either way I’m so glad you stood up to him. Jerk.

  9. Accidents, negligence, overcharging – these things are bad enough, but operating unnecessarily to increase revenue? I wonder how rampant this practice is? You acted honorably but not everyone does. Opening up these behind-the-scenes conversations is an important service deserving wider exposure.

  10. Ok, so you might want to get a shield ready for the Director bc I’m about to throw rotted veggies at his window.

    “Maybe you can find a little operation for her so that we can get a little more money”

    I would say (yell) !@#@$%^&^&^ EXCEPT I am not surprised. This is why I deplore the medical system and why you’re a saving face for THEM.

    Love and respect (in an angry huff),
    HW

    • Non profit hospitals make the most amount of money because they don’t pay taxes, but they usually also have the best equipment and care/staffing because they reinvest heavily in their hospital (this is my experience). I am afraid I have become a little unsympathetic towards patients who don’t pay their bills and cry foul when they are made to pay with interest and legal fees. I have been on the other side and it caused me endless amount of grief, time, money and angst trying to chase payments from patients. When you become a doctor you may also start resenting people who presume they should not have to pay for healthcare and that the healthcare companies and especially ‘rich’ doctors should not make a profit. I have been told too many times by patients that I should provide help for free, out of the goodness of my heart because that’s why I became a doctor.

Go on, say something! Let me know you've been to visit!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s