I spent a brief and disastrous year in the world of practice management groups, where patients were subsidiary to stock value and practice acquisition. I emerged bent but not broken. Well, maybe slightly broken. Yes, money is the root of all evil.
Next, I began to work for a community-based university practice, on a straight salary. My financial incentives were eliminated, I saw as many as I comfortably could, and I forgot about the money. Life was good. I had a few medical students and an intern. We saw a large but comfortable volume of patients, mostly geriatric. I always tried to see the people who needed to be seen, but not so many that a visit was too brief.
The dark side reared its head again when I got a new boss who wanted the community university practice to go on productivity. Once again I was back to the bean counting rat race: see more patients and squeeze in an extra three this afternoon. “What do you mean you want a day off?”
But then I became a hospitalist and all was right with the world again. It was an excellent consultative practice with ample opportunities for teaching and research. Unfortunately, when the resident hours rules began, we found ourselves staffing services formerly run by teaching teams. We also found ourselves in rotation with the remaining teams.
This was the moment of truth. Would I return to my long abandoned roots? Would I begin once again to order the “surf and turf” platter? Happily, the answer has been “No.” The fullness of time has helped me to realize that patients are not hot potatoes. There are days when I find myself watching the admit board intently or wondering why one service or another is not taking their bounce backs. I have found, however, that the mental energy that is wasted in playing Hot Potato is needed to care for the patients who seek our help. Would I want my mother sitting in an ED while three services did their best to not have her on their lists? OK, in my mom’s case, I could understand. (Just joking, Arlene.)
So, the next time you get the call from the ED and find yourself wondering what that patient is doing on your service, think about the game of Hot Potato. Perhaps when the music stops, you are the right one to have the spud in hand. TH
Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.