Wednesday, October 28, 2009

Gerald O'Malley, DO: How medicine is like buying tires

I have figured out what is the most irritating thing about emergency medicine (and that’s saying something, given all the irritating things that plague the ED physician).

It’s not the third year surgical resident with a face like a pasty Picasso sketch (from his early “sallow” period) that rolls his beady little bloodshot eyes thinking, “If I could only tell this idiot what I really think of him and his rule out APPY consult.” It’s not the frustration of having to buy the coffee and make the coffee, but not getting to drink the coffee, because while I was wrestling with a booger-encrusted alcoholic, the coffee pot poachers drank it all.

I have come to the conclusion that the single biggest irritant in practicing emergency medicine is when patients have all their tests and even surgeries at another hospital and then show up at my ED and expect me to deal with the complications (usually in the middle of the night, when getting medical records from another hospital is impossible).
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I practice in a city with a dozen different teaching hospitals in a five-mile radius. I’ve had patients undergo open heart surgery in one hospital, be discharged home, and then present to my ED on the same day complaining of chest pain. Naturally, the patient has no records that I can access, because he has never been a patient at my hospital and even if he had, it wouldn’t help because any record of recent procedures are all at the other hospital.

Good luck trying to contact the surgeon at the other hospital to return a page — if I’m lucky, I might get the on-call guy covering for the group that has no idea who the patient is or what procedure was done. Most times, the patients have no idea what procedure was performed and don’t bother to bring in any discharge paperwork from the first hospital.

My wife bought four new tires for her Toyota and within a day, trouble began. One tire went flat and needed to be replaced; the tire pressure indicator light came on numerous times, and the tires needed to be rotated and serviced. Each time a problem developed, my wife went back to the same tire shop and argued with the same tire guy who was convinced that my wife was somehow sabotaging his tires. She wouldn’t dream of going to a different tire shop and try to tell her story, because the guy in the second tire shop (analogous to me) wouldn’t have the first clue what the guys in the first tire shop had done.

Why do patients assume that medicine works any differently than buying tires?

The patients aren’t the only ones that assume medical information is somehow easy to access. Recently, a patient was delivered to my ED after having vomited in the back of an ambulance while being transported home after a prolonged stay in a neighboring hospital.

This patient had spent the better part of a year in the neighboring hospital and had undergone numerous procedures and had finally recovered sufficiently to go home, but became carsick on the way and instead of turning around and returning to the originating hospital (which was less than a half-mile away), the patient was delivered into my care — minus any information about the recent extended hospital stay.

A valiant attempt to retrieve some information from the other hospital was stymied because it was the weekend and the medical records department was closed. Fortunately, my emergency medicine brethren from the other hospital recognized my plight, and at great personal and financial risk to themselves, looked up and shared the details of the patient’s medical history, medications, and recent hospitalization with me, risking the wrath of the administrative HIPAApotami that monitor these sorts of things.

At least the tire guys don’t have to worry about violating HIPAA regulations.

Gerald O'Malley, DO, is the director of research in the largest, busiest emergency department in Philadelphia and an associate professor of emergency medicine at Thomas Jefferson University Hospital. He’s also the son of a NYC cop, die-hard Yankees fan, and a regular contributor to Practice Notes.


  1. Gerald- It's all about the money! Your wife goes back to the incompetent tire shop because another shop will charge her for new tires.

    Hospital care is FREE! Why go back to the place that messed you up when the next place is free? So what if you get another CT (or 5) or have 10 new consultants. It's free!

    By the way, HIPAA does not require a signed consent to share information amongst health care providers. Google "CMS SE0726" and choose the first hit to get the official paper. Fax that to anyone demanding a consent.

  2. Thanks for the tip. In my experience, it very often doesn't matter WHAT evidence you present, the default response at 11:00pm or on a weekend is for the temp-school-graduate working in medical records not to cooperate or share data under some HIPAA related concern.

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  4. Know exactly how you feel. I am a surgeon on Long Island. Patients go to Manhattan to get their surgery because we couldn't possible know how to do a colon resection out here in the sticks. Then when they have a problem, Manhattan is way to far for them to go. Now I'm supposed to take care of their complications when I wasn't good enough to do the procedure in the first place.

  5. I agree completely. The majority of the time, the patient doesn't even know the name of their procedure or what it was for.

    In regards to Jeff D.'s comment, this type of information needs to be exposed to the public. Patients need to be aware that doctors are not magical, all-knowing, all-seeing creatures, we are human beings and need as much information as possible to practice good medicine.

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