(Snippets from the frontline)
Permission denied
I received a phone call from a hospital case manager that my patient did not meet criteria for further admission and should be discharged. Unfortunately, the patient was just removed from a breathing machine, and was still in the ICU for sepsis.
There are several criteria used by hospitals guiding whether a patient should be admitted or discharged. Who establishes these criteria? Hospitals of course, with evidence-based bias to divert money into their pockets.
This conspiracy by business people has been detrimental to the quality of healthcare the American people receive when hospitalization is required.
With almost 40 years of practice and experience, I remain up to date on how to provide scientific evidence-based care to patients. Unfortunately, I now have to ask permission for a patient to be admitted, have certain testing and procedures, and remain in the hospital setting.
Asking for permission from those in authority who ultimately benefit from denial is not only intuitively wrong, but crosses the boundary of moral and ethical sense.
It also violates the Hippocratic Oath I have taken, and reminds me they have only taken an oath to benefit themselves.
Gene Uzawa Dorio, M.D.
Shamefully, the story is true.
Gene Uzawa Dorio, M.D.
As a hospital case manager I would have to say that I do not believe this story as a patient just being extubated always meets continued stay criteria for the ICU level of care. Many physicians use case managers as an excuse for having to manage their patients effectively at the appropriate levels of care as they do not want to tell their patients that they really no longer need continued hospitalization so it is just easier to blame the case managers! BUT! Remember it is only a doctor who can admit transfer or discharge a patient! An RN case manager CANNOT do this and never has. It’s just easier to blame us for the decisions they know their patients won’t like!!
It so sad that we allowed the pendulum to swing so far to the left. We have to take the power back and take a stance. I don’t know how a business can hold all of the cards, monopolizing an entire industry, like the healthcare insurance companies have succeeded in doing, setting the house pricing according to their idea of a “reasonable and standard” fee schedule, even though they profit from undercoverage for services, while holding physicians hostage on provider panels. There a conflict of interest somewhere in there.
“I received a phone call from a hospital case manager that my patient did not meet criteria for further admission and should be discharged. Unfortunately, the patient was just removed from a breathing machine, and was still in the ICU for sepsis.”
That “case manager” must have been a scholar of “007 medicine”. (Agent James Bond, 007-licensed to kill)
Hospitals are not humanitarians in the US. They are for profit and naturally their management is to make money.