Re: Re: IMP practice call failure

[Guest guest]

Lynn,

What a terrible story! However, if you have the appropriate things in

place and someone tries to reach you at home (not the standard method of

contacting you) and you are not there, you cannot do anything! This is

not your fault! The patient should have called the office or gone to the

ER directly. I know it doesn't make you feel any better about the

outcome, but you were there via your cell phone. This is not a failure

of you or your processes, this is simply a bad outcome. You need to take

vacations in order to be there long term for your patients. Don't let

this bad outcome scare you out of ever leaving the home. That would

likely be far more tragic for you and your patients.

Re: IMP practice call failure

So I think I was right about feeling uncomfortable about leaving for

vacation.

I went away for a 3 day weekend- first one ever- and while I was gone,

one

of my very old patients - they are a couple, 85 and 87- called me

Friday

night and Saturday morning at my home, left a message stating his wife

was

very sick, essentially non responsive, could I call him back, he didn't

know

what to do. I got home on Sunday night and called him. Turns out his

wife may have had a stroke a few days previously, was admitted to the

unit

hypothermic with a temperature of 86, unresponsive and with a very low

blood

pressure on Saturday mid day. After he decided he couldn't reach me he

called her psychiatric provider who told him to bring her to the ER.

He never called my office where I had clear instructions to call my cell

phone, he just assumed I would not be in the office and called me at

home.

I had never given him my home phone number but that was where he

originally

found the practice and must have had the number socked away somewhere,

he

had left me messages at my home before (and I think I had asked him to

use

the office phone at those times, since it wouldn't be a sure thing to

find

me at home).

What a crappy thing to have happen. I wonder if he had been able to

reach

me sooner if her outcome would have been better (probably). Today she

remains comatose and responsive to pain.

So I will put a message on my home answering machine which states - if

this

is a medical urgency to call my office number where my contact

information

will be clearly stated.

I don't think this kind of thing happens in mega practices where no one

looks up your phone number in the phone book to find you.

I am really sad about this one.

Lynn

_________________________________________________________________

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[Guest guest]

Lynn,

Sorry to hear about this situation but you have to know that you did

nothing wrong. You had advised the gentleman that he needed to call your

office instead of your home and to be honest, common sense should dictate

that anyhow. Besides, it seems like he has poor judgement because he

probably should have called 911 from the beginning if his wife was doing

so poorly. It is too bad this will put a damper on your willingness to

take some time for yourself. Remember, we need to take care of ourselves

in order to better care for our patients and our families.

Margaret Coughlan

>

> So I think I was right about feeling uncomfortable about leaving for

> vacation.

>

> I went away for a 3 day weekend- first one ever- and while I was gone,

> one of my very old patients - they are a couple, 85 and 87- called me

> Friday night and Saturday morning at my home, left a message stating

> his wife was very sick, essentially non responsive, could I call him

> back, he didn't know what to do. I got home on Sunday night and

> called him. Turns out his wife may have had a stroke a few days

> previously, was admitted to the unit hypothermic with a temperature of

> 86, unresponsive and with a very low blood pressure on Saturday mid

> day. After he decided he couldn't reach me he called her psychiatric

> provider who told him to bring her to the ER. He never called my office

> where I had clear instructions to call my cell phone, he just assumed I

> would not be in the office and called me at home. I had never given

> him my home phone number but that was where he originally found the

> practice and must have had the number socked away somewhere, he had

> left me messages at my home before (and I think I had asked him to use

> the office phone at those times, since it wouldn't be a sure thing to

> find me at home).

> What a crappy thing to have happen. I wonder if he had been able to

> reach me sooner if her outcome would have been better (probably).

> Today she remains comatose and responsive to pain.

> So I will put a message on my home answering machine which states - if

> this is a medical urgency to call my office number where my contact

> information will be clearly stated.

> I don't think this kind of thing happens in mega practices where no one

> looks up your phone number in the phone book to find you.

>

> I am really sad about this one.

>

> Lynn

>

> _________________________________________________________________

> Find what you need at prices you’ll love. Compare products and save at

> MSN® Shopping.

>

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01

>

>

>

>

>

>

[Guest guest]

Lynn,

I share your dismay at having your patient fall ill while you were

gone, but sometimes even when you do everything you can, it still

doesn't make a difference. Case in point, I recently I saw a 40-some

year old previously healthy woman who had called at 8AM that day

hoping for an appointment, or at least the name of someone else she

could see, since my message said I wasn't accepting new patients. Her

voice was so broken up that I could barely make out the phone number

to call her back at. Lately I'd been telling patients 'sorry but I'm

closed to new patients and here are some other doctors you can call'.

But I guess I felt sorry for someone who sounded so sick so I told

her to come in at 11:30AM. She came in with her husband and she could

barely fill out her paperwork because she was so weak from having the

flu for the past week and a half. By the time I finished seeing the

patient before her, she was too weak to even get out of the chair in

the waiting room, so I started taking the history right there from

her husband. I tried to get a pulse ox but it wouldn't register. As I

called 911, she became unresponsive. The paramedics arrived within 5

minutes, and took her to the local ER. I found out the next morning

that despite massive resuscitation efforts and despite having no

significant medical problems, she passed away that evening from

severe pneumonia.

If I had seen her even 5 or 10 minutes earlier, would I have been

able to save her life? I will never know. I take some small solace in

thinking that if I hadn't seen her that morning, that she would've

died at home since she probably wouldn't have been able to get an

appointment that day with any other physician.

Anyways, this is why doctors need to take vacations, to help de-

stress. Plus, maybe you should make your home phone unlisted so

patients can't call you there.

" God, grant me the serenity to accept the things I cannot change, the

courage to change the things I can, and the wisdom to know the

difference. " -Reinhold Niebuhr

Seto

South Pasadena, CA

>

> So I think I was right about feeling uncomfortable about leaving for

> vacation.

>

> I went away for a 3 day weekend- first one ever- and while I was

> gone, one

> of my very old patients - they are a couple, 85 and 87- called me

> Friday

> night and Saturday morning at my home, left a message stating his

> wife was

> very sick, essentially non responsive, could I call him back, he

> didn't know

> what to do. I got home on Sunday night and called him. Turns

> out his

> wife may have had a stroke a few days previously, was admitted to

> the unit

> hypothermic with a temperature of 86, unresponsive and with a very

> low blood

> pressure on Saturday mid day. After he decided he couldn't reach

> me he

> called her psychiatric provider who told him to bring her to the ER.

> He never called my office where I had clear instructions to call my

> cell

> phone, he just assumed I would not be in the office and called me

> at home.

> I had never given him my home phone number but that was where he

> originally

> found the practice and must have had the number socked away

> somewhere, he

> had left me messages at my home before (and I think I had asked him

> to use

> the office phone at those times, since it wouldn't be a sure thing

> to find

> me at home).

> What a crappy thing to have happen. I wonder if he had been able

> to reach

> me sooner if her outcome would have been better (probably). Today she

> remains comatose and responsive to pain.

> So I will put a message on my home answering machine which states

> - if this

> is a medical urgency to call my office number where my contact

> information

> will be clearly stated.

> I don't think this kind of thing happens in mega practices where no

> one

> looks up your phone number in the phone book to find you.

>

> I am really sad about this one.

>

> Lynn

>

> _________________________________________________________________

> Find what you need at prices you’ll love. Compare products and save

> at MSN®

> Shopping.

> http://shopping.msn.com/default/shp/?

> ptnrid=37,ptnrdata=24102 & tcode=T001MSN20A0701

>

>

>

>

[Guest guest]

I was wondering, do most people when they are on vacation and out of town take their own phone calls or do they they sign out to someone else. I have usually been taking my own calls but my partner is available to see them if they need to be seen. Some times I feel that I might be a workaholic because I don't transfer my calls except on rare occasions.Larry Lindeman MDLynn,What a terrible story! However, if you have the appropriate things inplace and someone tries to reach you at home (not the standard method ofcontacting you) and you are not there, you cannot do anything! This isnot your fault! The patient should have called the office or gone to theER directly. I know it doesn't make you feel any better about theoutcome, but you were there via your cell phone. This is not a failureof you or your processes, this is simply a bad outcome. You need to takevacations in order to be there long term for your patients. Don't letthis bad outcome scare you out of ever leaving the home. That wouldlikely be far more tragic for you and your patients.-----Original Message-----From: [mailto: ] On Behalf Of lynn hoSent: Monday, March 05, 2007 8:16 PMTo: Subject: Re: IMP practice call failureSo I think I was right about feeling uncomfortable about leaving for vacation.I went away for a 3 day weekend- first one ever- and while I was gone,one of my very old patients - they are a couple, 85 and 87- called meFriday night and Saturday morning at my home, left a message stating his wifewas very sick, essentially non responsive, could I call him back, he didn'tknow what to do. I got home on Sunday night and called him. Turns out hiswife may have had a stroke a few days previously, was admitted to theunit hypothermic with a temperature of 86, unresponsive and with a very lowblood pressure on Saturday mid day. After he decided he couldn't reach me he called her psychiatric provider who told him to bring her to the ER.He never called my office where I had clear instructions to call my cellphone, he just assumed I would not be in the office and called me athome. I had never given him my home phone number but that was where heoriginally found the practice and must have had the number socked away somewhere,he had left me messages at my home before (and I think I had asked him touse the office phone at those times, since it wouldn't be a sure thing tofind me at home).What a crappy thing to have happen. I wonder if he had been able toreach me sooner if her outcome would have been better (probably). Today she remains comatose and responsive to pain.So I will put a message on my home answering machine which states - ifthis is a medical urgency to call my office number where my contactinformation will be clearly stated.I don't think this kind of thing happens in mega practices where no one looks up your phone number in the phone book to find you.I am really sad about this one.Lynn__________________________________________________________Find what you need at prices you'll love. Compare products and save atMSNR Shopping. http://shopping.msn.com/default/shp/?ptnrid=37,ptnrdata=24102 & tcode=T001MSN20A0701

[Guest guest]

Oh, Lynn, I'm so sorry you have gotten stuck this way. It is so hard

to control how people behave, especially when they are stressed.

Keep in mind that even if you were in a mega group, if you, like me,

made a habit of giving out your personal contact info and encouraging

people to go around the formal call mechanism, this could happen even in

a big group. 99% of the time, I would rather that people I knew call me,

rather than risk being blown off by my call partners...but if that one

time I happened to be outside pager range was when they called....I

tried to make sure they understood " plan B " but they didn't always get

it, or couldn't remember...

This reminds me that I have been planning to write a formal " disaster

plan " to put in people's hands, that gives them a step-by-step list of

what numbers to call, in what order, if they need me outside office

hours, especially if I don't answer the cell phone.

I would tell you not to beat yourself up, but you will do it anyway. So

instead I will just say keep your dear little lady close to your heart,

remember her, and work to protect those who follow her from the

isolation that old age brings in our society. But that doesn't mean

never go on vacation; it just means weave the safety net as best you

can.

And don't forget to forgive yourself.

Annie

Re: IMP practice call failure

So I think I was right about feeling uncomfortable about leaving for

vacation.

I went away for a 3 day weekend- first one ever- and while I was gone,

one

of my very old patients - they are a couple, 85 and 87- called me

Friday

night and Saturday morning at my home, left a message stating his wife

was

very sick, essentially non responsive, could I call him back, he didn't

know

what to do. I got home on Sunday night and called him. Turns out his

wife may have had a stroke a few days previously, was admitted to the

unit

hypothermic with a temperature of 86, unresponsive and with a very low

blood

pressure on Saturday mid day. After he decided he couldn't reach me he

called her psychiatric provider who told him to bring her to the ER.

He never called my office where I had clear instructions to call my cell

phone, he just assumed I would not be in the office and called me at

home.

I had never given him my home phone number but that was where he

originally

found the practice and must have had the number socked away somewhere,

he

had left me messages at my home before (and I think I had asked him to

use

the office phone at those times, since it wouldn't be a sure thing to

find

me at home).

What a crappy thing to have happen. I wonder if he had been able to

reach

me sooner if her outcome would have been better (probably). Today she

remains comatose and responsive to pain.

So I will put a message on my home answering machine which states - if

this

is a medical urgency to call my office number where my contact

information

will be clearly stated.

I don't think this kind of thing happens in mega practices where no one

looks up your phone number in the phone book to find you.

I am really sad about this one.

Lynn

_________________________________________________________________

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Shopping.

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MSN20A0701

[Guest guest]

I have

not left for more than a day except to go to the Scientific Assembly for the

past three years. If I am going to

be back in town within 24 hours I just edit my voice mail message to say I am

out of town but will be checking messages and then I check messages. And the first statement on the voice mail

message after “thank you for calling Dr. Skaggs” is “If

you are having a medical emergency, please hang up and call 911”

When I leave town for a week, I have

another doc available for urgent needs and I put her number on my voice mail….

I don’t have a home answering

machine, so nobody leaves messages at the house…

Annie

Re: IMP practice call failure

So I think I was right about feeling uncomfortable

about leaving for

vacation.

I went away for a 3 day weekend- first one ever-

and while I was gone,

one

of my very old patients - they are a couple, 85

and 87- called me

Friday

night and Saturday morning at my home, left a

message stating his wife

was

very sick, essentially non responsive, could I

call him back, he didn't

know

what to do. I got home on Sunday night and called

him. Turns out his

wife may have had a stroke a few days previously,

was admitted to the

unit

hypothermic with a temperature of 86, unresponsive

and with a very low

blood

pressure on Saturday mid day. After he decided he

couldn't reach me he

called her psychiatric provider who told him to

bring her to the ER.

He never called my office where I had clear

instructions to call my cell

phone, he just assumed I would not be in the

office and called me at

home.

I had never given him my home phone number but

that was where he

originally

found the practice and must have had the number

socked away somewhere,

he

had left me messages at my home before (and I

think I had asked him to

use

the office phone at those times, since it wouldn't

be a sure thing to

find

me at home).

What a crappy thing to have happen. I wonder if he

had been able to

reach

me sooner if her outcome would have been better

(probably). Today she

remains comatose and responsive to pain.

So I will put a message on my home answering

machine which states - if

this

is a medical urgency to call my office number

where my contact

information

will be clearly stated.

I don't think this kind of thing happens in mega

practices where no one

looks up your phone number in the phone book to

find you.

I am really sad about this one.

Lynn

__________________________________________________________

Find what you need at prices you'll love. Compare

products and save at

MSNR

Shopping.

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MSN20A0701

[Guest guest]

I’ve never transferred my calls,

even when I was on a cruise (relied on email and notified pts of that on all my

answering devices), and on a sailing trip (had a satellite phone), since I

started 7/03. Every once in a while I wonder if I should (maybe 3 minutes

a year) punt my calls, but then I remember what great patients I have in

general, and they don’t abuse me.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Larry Lindeman

Sent: Monday, March 05, 2007 7:32

PM

To:

Subject: Re:

Re: IMP practice call failure

I was

wondering, do most people when they are on vacation and out of town take their

own phone calls or do they they sign out to someone else. I have usually been

taking my own calls but my partner is available to see them if they need to be

seen. Some times I feel that I might be a workaholic because I don't transfer

my calls except on rare occasions.

Larry Lindeman MD

[Guest guest]

Gosh, figures that would happen. So sorry to hear that.

I've been out of town several times (to Salt Lake City Shriners with my

youngest) for several days at a time, in addition to week long vacations,

and have never had this happen. Don't beat yourself up over it, although I

know that is hard for you not to do. That one was not an urgent situation,

but an emergent one, and unfortunately the husband didn't recognize it. He

should have called 911. Even if he knew that already, he may have blitzed

it in the situation - you can't blame yourself for that.

I've made a habit of reviewing how to contact me with my patients at their

initial appt. Not everyone gets it perfectly, but I haven't had a situation

anything like that happen - maybe I've been lucky.

You can't expect yourself to be omnipresent, and neither can your patients.

Hang in there...

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

Re: IMP practice call failure

So I think I was right about feeling uncomfortable about leaving for

vacation.

I went away for a 3 day weekend- first one ever- and while I was gone, one

of my very old patients - they are a couple, 85 and 87- called me Friday

night and Saturday morning at my home, left a message stating his wife was

very sick, essentially non responsive, could I call him back, he didn't know

what to do. I got home on Sunday night and called him. Turns out his

wife may have had a stroke a few days previously, was admitted to the unit

hypothermic with a temperature of 86, unresponsive and with a very low blood

pressure on Saturday mid day. After he decided he couldn't reach me he

called her psychiatric provider who told him to bring her to the ER.

He never called my office where I had clear instructions to call my cell

phone, he just assumed I would not be in the office and called me at home.

I had never given him my home phone number but that was where he originally

found the practice and must have had the number socked away somewhere, he

had left me messages at my home before (and I think I had asked him to use

the office phone at those times, since it wouldn't be a sure thing to find

me at home).

What a crappy thing to have happen. I wonder if he had been able to reach

me sooner if her outcome would have been better (probably). Today she

remains comatose and responsive to pain.

So I will put a message on my home answering machine which states - if this

is a medical urgency to call my office number where my contact information

will be clearly stated.

I don't think this kind of thing happens in mega practices where no one

looks up your phone number in the phone book to find you.

I am really sad about this one.

Lynn

[Guest guest]

Dear Lynn

I think we feel uncomfortable about alot of things we can't control

alot of the time, not just taking vacations.

I've been caring for my 84 year old neighbor post op for a week now.

He's usually on Coumadin, had to get Lovenox BID, his wife couldn't

give it to him, etc, etc. So I " ve been giving all the shots and

following him.

And he developed a gradually worsening hematoma at the inguinal

hernia site and in the end, he just had to be transported back to the

hospital by ambulance to see the surgeon, get his anti-coagulant

reversed and get the hematoma evacuated. So I feel bad and guilty,

rather than amazed at everything I did for the last week.

What I didn't do:

1 Give him atrial fibrillation.

2 Make him 84

3 Give him that arterial thrombosis he had three months ago when he

forgot to take his Coumadin, making it essential to keep him anti-

coagulated this time.

4 Tell him to lift that entire roll of carpet by himself, to start

the hernia.

5 Tell him to dig the tree root out the day before the hernia became

incarcerated.

6 Do the inguinal hernia repair, for that matter. . .

But, I was the one agonizing about his clinical condition, his coags,

whether to continue the Lovenox with the hematoma. You name it, I

agonized it.

It's part of our personality defect that makes us good doctors, bad

for ourselves.

If your patient had a stroke, was non-responsive and hypothermic,

then I would suggest that while you might have felt better being

available to offer the husband comfort, you would have not been able

to do anything else for her, agonizing about that also.

And as far as mega-practices go, I used to get messages on every

phone number you could imagine (and probably some I didn't even know

about), and our " mega practice " in the old days managed to leave a

defunct answering service phone number in the phone book for years. I

finally got rid of it myself.

I am very sorry about your patient, it feels so horrible to " fail

people, " even if that isn't what we've done.

xx

>

> So I think I was right about feeling uncomfortable about leaving for

> vacation.

>

> I went away for a 3 day weekend- first one ever- and while I was

> gone, one

> of my very old patients - they are a couple, 85 and 87- called me

> Friday

> night and Saturday morning at my home, left a message stating his

> wife was

> very sick, essentially non responsive, could I call him back, he

> didn't know

> what to do. I got home on Sunday night and called him. Turns

> out his

> wife may have had a stroke a few days previously, was admitted to

> the unit

> hypothermic with a temperature of 86, unresponsive and with a very

> low blood

> pressure on Saturday mid day. After he decided he couldn't reach

> me he

> called her psychiatric provider who told him to bring her to the ER.

> He never called my office where I had clear instructions to call my

> cell

> phone, he just assumed I would not be in the office and called me

> at home.

> I had never given him my home phone number but that was where he

> originally

> found the practice and must have had the number socked away

> somewhere, he

> had left me messages at my home before (and I think I had asked him

> to use

> the office phone at those times, since it wouldn't be a sure thing

> to find

> me at home).

> What a crappy thing to have happen. I wonder if he had been able

> to reach

> me sooner if her outcome would have been better (probably). Today she

> remains comatose and responsive to pain.

> So I will put a message on my home answering machine which states

> - if this

> is a medical urgency to call my office number where my contact

> information

> will be clearly stated.

> I don't think this kind of thing happens in mega practices where no

> one

> looks up your phone number in the phone book to find you.

>

> I am really sad about this one.

>

> Lynn

>

> _________________________________________________________________

> Find what you need at prices you’ll love. Compare products and save

> at MSN®

> Shopping.

> http://shopping.msn.com/default/shp/?

> ptnrid=37,ptnrdata=24102 & tcode=T001MSN20A0701

>

>

>

>

[Guest guest]

When I have gone out of town, if I know my cell is in range, I just take my own calls. If I know my cell won't be, I have used a local doctor who was also solo, practicing a very IMP practice as well. This worked well for each of us, for the 2-4x a year we would truly be unavailable. Neither of us does hospital work, has partners, or takes government payors. If necessary we saw each other's patients. Lately though, she is going more cosmetic, and doing less and less medical. I have brought in temps that I know personally, to cover the office, but each and every time, they sit mostly idle all day, and I am swamped when I come back, with patients who "just wanted to wait and see you". 2 wks ago, I left town for 8 days, my covering doctor was also going to be out of town. I have an urgent care 5 minutes from my office. So my answering machine on the office phone said I was out of town, and unavailable, if you h

ave an emergeny, hang up and call 911, if you need to speak to a doctor or be seen by a doctor go the X Urgent Care, if you need a routine appointment for follow up or refills, leave a message and we will schedule you when we return. I do not give patients my home number, I have a 13 and a 11 yr old, they may answer or worse my husband might take a message and I'd never get it. Seriously though, I don't think anyone needs to call me at my home number, they always have my cell, it rings here, I can pick up, or call right back.

I have been doing it this way for 4 yr, and so far, no disasters.

-------------- Original message --------------

I was wondering, do most people when they are on vacation and out of town take their own phone calls or do they they sign out to someone else. I have usually been taking my own calls but my partner is available to see them if they need to be seen. Some times I feel that I might be a workaholic because I don't transfer my calls except on rare occasions.

Larry Lindeman MD

Lynn,What a terrible story! However, if you have the appropriate things inplace and someone tries to reach you at home (not the standard method ofcontacting you) and you are not there, you cannot do anything! This isnot your fault! The patient should have called the office or gone to theER directly. I know it doesn't make you feel any better about theoutcome, but you were there via your cell phone. This is not a failureof you or your processes, this is simply a bad outcome. You need to takevacations in order to be there long term for your patients. Don't letthis bad outcome scare you out of ever leaving the home. That wouldlikely be far more tragic for you and your patients.-----Original Message-----From: [mailto: ] On Behalf Of lynn hoSent: Monday, March 05, 2007 8:16 PMTo: Subject:

Re: IMP practice call failureSo I think I was right about feeling uncomfortable about leaving for vacation.I went away for a 3 day weekend- first one ever- and while I was gone,one of my very old patients - they are a couple, 85 and 87- called meFriday night and Saturday morning at my home, left a message stating his wifewas very sick, essentially non responsive, could I call him back, he didn'tknow what to do. I got home on Sunday night and called him. Turns out hiswife may have had a stroke a few days previously, was admitted to theunit hypothermic with a temperature of 86, unresponsive and with a very lowblood pressure on Saturday mid day. After he decided he couldn't reach me he called her psychiatric provider who told him to bring her to the ER.He never called my office where I had clear instructions to call my cellphone, he just assumed I would not be in the office and called me athome. I had never given him my home phone number but that was where heoriginally found the practice and must have had the number socked away somewhere,he had left me messages at my home before (and I think I had asked him touse the office phone at those times, since it wouldn't be a sure thing tofind me at home).What a crappy thing to have happen. I wonder if he had been able toreach me sooner if her outcome would have been better (probably). Today she remains comatose and responsive to pain.So I will put a message on my home answering machine which states - ifthis is a medical urgency to call my office number where my contactinformation will be clearly stated.I don't think this kind of thing happens in mega practices where no one looks up your phone number in the phone book to find you.I am really sad about this one.Lynn__________________________________________________________Find what you need at pr

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[Guest guest]

Dear Lynn & ,

Just want to commiserate with you

guys. My 46 year old neighbor with ovarian

cancer died 2 weeks ago. I also had been giving

her Lovenox (although mostly only once a day, but

sometimes twice) and seeing her almost daily

since July. I was out of town for 3 days over

President's Day weekend and told her I'd see her

when I returned Sunday night. My flight was

late, I was tired, and hadn't seen my family, so

I decided to go see her the next

morning. Needless to say, I got a call at 1:30

am and by the time I was at her house 10 minutes

later she had died. I was really kicking myself

because I wasn't with her that weekend and when

she passed on. (Her husband and her didn't

really get along anymore.) Her niece was

present, so it was OK, but I still felt terrible.

But, of course, we are human, need to

maintain our other relationships, our health, and

our sanity in order to be good healers. And

is right (as usual), it is a personality

trait that is good for our patients, but hard on us.

It helped me to believe that once she

heard I was coming the night died, she felt OK

and let go. I'll never know, and time has helped

me to recognize the benefits of our relationship

over the last 8 months. The perfectionist in me

may never be able to let go of the fact that I

didn't go over there right when I got back into town.

It is hard to imagine that someone

wouldn't call 911 with an unresponsive

spouse. Yes, we need to tell them, but probably

a good part of that is medico-legal rather than

practical because if someone can't figure that

out on their own, who knows if a message will

help? So, Lynn, hopefully you can be of some

comfort to the husband now, and keep up the good

work for your future patients. And Lynn and

, of course we don't cause the disease, but

we get to be the one who misses the process the

first moment it appears, only to recognize it as

the story unfolds. Oh, the perils and joys of being on the front line.

Sharon

At 08:12 PM 3/5/2007, you wrote:

>Dear Lynn

>

>I think we feel uncomfortable about alot of things we can't control

>alot of the time, not just taking vacations.

>

>I've been caring for my 84 year old neighbor post op for a week now.

>He's usually on Coumadin, had to get Lovenox BID, his wife couldn't

>give it to him, etc, etc. So I " ve been giving all the shots and

>following him.

>And he developed a gradually worsening hematoma at the inguinal

>hernia site and in the end, he just had to be transported back to the

>hospital by ambulance to see the surgeon, get his anti-coagulant

>reversed and get the hematoma evacuated. So I feel bad and guilty,

>rather than amazed at everything I did for the last week.

>

>What I didn't do:

>1 Give him atrial fibrillation.

>2 Make him 84

>3 Give him that arterial thrombosis he had three months ago when he

>forgot to take his Coumadin, making it essential to keep him anti-

>coagulated this time.

>4 Tell him to lift that entire roll of carpet by himself, to start

>the hernia.

>5 Tell him to dig the tree root out the day before the hernia became

>incarcerated.

>6 Do the inguinal hernia repair, for that matter. . .

>

>But, I was the one agonizing about his clinical condition, his coags,

>whether to continue the Lovenox with the hematoma. You name it, I

>agonized it.

>It's part of our personality defect that makes us good doctors, bad

>for ourselves.

>

>If your patient had a stroke, was non-responsive and hypothermic,

>then I would suggest that while you might have felt better being

>available to offer the husband comfort, you would have not been able

>to do anything else for her, agonizing about that also.

>

>And as far as mega-practices go, I used to get messages on every

>phone number you could imagine (and probably some I didn't even know

>about), and our " mega practice " in the old days managed to leave a

>defunct answering service phone number in the phone book for years. I

>finally got rid of it myself.

>

>I am very sorry about your patient, it feels so horrible to " fail

>people, " even if that isn't what we've done.

>

>xx

>

>

>

>

> >

> > So I think I was right about feeling uncomfortable about leaving for

> > vacation.

> >

> > I went away for a 3 day weekend- first one ever- and while I was

> > gone, one

> > of my very old patients - they are a couple, 85 and 87- called me

> > Friday

> > night and Saturday morning at my home, left a message stating his

> > wife was

> > very sick, essentially non responsive, could I call him back, he

> > didn't know

> > what to do. I got home on Sunday night and called him. Turns

> > out his

> > wife may have had a stroke a few days previously, was admitted to

> > the unit

> > hypothermic with a temperature of 86, unresponsive and with a very

> > low blood

> > pressure on Saturday mid day. After he decided he couldn't reach

> > me he

> > called her psychiatric provider who told him to bring her to the ER.

> > He never called my office where I had clear instructions to call my

> > cell

> > phone, he just assumed I would not be in the office and called me

> > at home.

> > I had never given him my home phone number but that was where he

> > originally

> > found the practice and must have had the number socked away

> > somewhere, he

> > had left me messages at my home before (and I think I had asked him

> > to use

> > the office phone at those times, since it wouldn't be a sure thing

> > to find

> > me at home).

> > What a crappy thing to have happen. I wonder if he had been able

> > to reach

> > me sooner if her outcome would have been better (probably). Today she

> > remains comatose and responsive to pain.

> > So I will put a message on my home answering machine which states

> > - if this

> > is a medical urgency to call my office number where my contact

> > information

> > will be clearly stated.

> > I don't think this kind of thing happens in mega practices where no

> > one

> > looks up your phone number in the phone book to find you.

> >

> > I am really sad about this one.

> >

> > Lynn

> >

> > _________________________________________________________________

> > Find what you need at prices you’ll love. Compare products and save

> > at MSN®

> > Shopping.

> > http://shopping.msn.com/default/shp/?

> > ptnrid=37,ptnrdata=24102 & tcode=T001MSN20A0701

> >

> >

> >

> >