Wednesday, January 20, 2010

Gerald O'Malley, DO: I can't help you, part 1

When I enter a patient’s room, I make it a point to demonstrate to the patient that I wash my hands or I squirt some hand sanitizer on before I touch them and my introduction is the same for every patient; “Hi, I’m Dr. O’Malley. How can I help you today?” I got into this line of work because I genuinely enjoy helping people. Today, I felt like I didn’t do such a good job helping anyone.

The first patient I saw today was a young lady that told me that she was losing weight. She wasn’t trying to lose weight and her appetite was good, but her mother and sisters told her she was losing weight. At one time she weighed 122 lbs.
“How much do you weigh now?” I asked.
“I don’t know,” she replied.
“Well then how do you know you are losing weight?”
“Because everyone tells me I am.”
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The patient wanted to be tested for a variety of different disease including but not limited to cancer and lupus. I told her that the ER isn’t really the place to begin a workup for any of these chronic diseases and I could provide her with a list of excellent primary-care providers that might help her. She was unconvinced and wanted something other than my reassurance. Having no insurance or source of income limited her ability to access a doctor that might help her.

“Well, let’s talk about this,” I offered. “How long have you been losing weight?”
“About five days.”
“You don’t need any testing. You need to go home and find a scale and try to figure out if you are actually losing weight or not. If you are losing weight, you need to make an appointment with a primary care doctor and get a check-up. If you like, I can have you talk with our social workers in order to begin your application for Medicaid. I’m sorry but I can’t help you.”

The patient became upset, called me a racial epithet under her breath and stomped out of the ER.

The ER has always been the great dumping ground for patients with no place else to go. Most ER doctors pride themselves as being strong patient advocates. I have argued, bullied, pleaded and bargained with other doctors to help my patients. Most doctors, when push comes to shove, will do the right thing for the patient even though it means that they will lose sleep, not be paid and increase their malpractice risk.

One recent case that comes to mind was the illegal immigrant that accidentally put his hand through a circular saw while at a worksite. He had presented to another ER (located on the “Main Line” – the southwestern suburbs of Philadelphia famous for the gorgeous old staid mansions and outrageously overpriced condos), was bandaged up, and given a map with directions to my hospital. He showed up in my ER with an injury that might have required an amputation had it not been for some gentle arm twisting on my part and a heroic effort on the surgeon’s part – all without compensation and with the shadow of the trial lawyer bribing OR nurses and techs for leads on possible malpractice cases. (I personally know ER nurses and techs that have been offered money from trial lawyers to “keep your eyes open” for information on any potential malpractice cases.)

Some days, I just can’t seem to help anyone.

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