The Cheerful Oncologist

I had the unique occasion this weekend (which is a euphemism for “I was stuck on-call”) to review a summary outlining the details of a guest appearance made by a patient to the hospital’s emergency room. The individual in question, prior to being admitted with the diagnosis of some type of frightful ailment or another, first visited the E. R. Myself (playing the role of “Covering Physician” while lounging around the nurses’ station like a hobo in an Alabama diner, with only a paucity of listlessness I might add) decided to read this report.

It was the most amazing thing I had laid eyes on all summer. I sat mesmerized, scrutinizing page after page until finally I heard a voice asking if I was alright. After repeating the question sotto voce and coming to the conclusion that I was, I broke out of the spell and vowed to finish my work more efficiently, if for no other reason than to segue to my exhilarating plans for the rest of the day. I forced myself away from the chart and on to my appointed rounds.

Later, while driving home, my thoughts drifted back to that emergency room report. It wasn’t the facts in the case that captivated me; the patient’s illness was serious but manageable, and he had improved since his admission.

It was the macros used by the E. R. doctors and nurses in their typewritten report that were stunning. They spilled over the pages, neatly stacked into parallel lines, all created to prove conclusively to any skeptics that at no time while physically present in the emergency room did the patient receive anything less than perfect care. The result was a repetitive – nay, interminable, tedious, irksome collection of about a hundred paragraphs that contained just under ten percent factual information.

The rest was just a pile of crap that I inferred was placed there for the sole purpose of vexing malpractice lawyers.

Don’t get me wrong – I understand the importance of careful documentation of the events of the day inside a hospital or medical office. I get it when I’m told to leave good records of what I say to my patients. It’s just that in this particular case the result is an unintentionally hilarious narrative. Let me illustrate by providing an example of a visit to a local hamburger joint, as chronicled by the restaurant’s risk management team:

“The client, who walked into the lobby on his own power, had no signs of distress. He was promptly escorted to the nearest counter by staff member One. He completed this ambulation without injury. The client was asked how he felt before the Staff Member departed. The client said he felt fine, but did complain of a feeling of hunger in the vicinity of his abdomen. He was promptly examined by the staff member and found to not contain any foreign objects protruding from his abdomen or chest.

“The client placed his order for a hamburger, large fries and medium coffee. He did not show any signs of distress while waiting for his order, and was checked on by staff members One and Two at 1457 hours and again at 1502 hours. The client did not fall down at any time during his wait, but he did show brief signs of distress upon hearing the score of the Cardinals-Cubs baseball game, which was being broadcast from a nearby radio.

“When the client paid for his food he was asked how he felt. He said that he felt fine. He was personally escorted to his table by Staff Member Three. He exhibited no signs of injury during his walk to the table, which was completed on his own power. He then sat down at the table and voiced the complaint that his left buttock was wet. He was promptly evaluated by Staff Member Three and found to have been sitting on an open catsup packet. The catsup was partially removed from the client’s trousers without difficulty by the client, who was attended by Staff Members One and Three throughout this process. The client was then asked how he felt, and he replied that he felt fine, if not a little “tomatoey” (client term).

“Prior to removing the lid from his medium cup of coffee the client signed Forms 2362 and Sub-Form 13A (Standard Disclaimers and Consent to Consume Hot Beverages). The client understood the risks and side-effects of consuming his medium cup of coffee and was in a sound state of mind throughout his visit. He consumed the coffee without incident under the direct visual supervision of the Manager. The client did state that the coffee tasted like the south end of an Irish wolfhound facing north. The coffee was replaced and the original specimen sealed for analysis by the central office. The client was then asked how he felt, and he replied that despite the fact that he dropped one of his french fries, he felt fine.

“The french fry was examined and found not to have produced any injury to the client, although it was later inadvertantly destroyed by a wandering female client, estimated age of three years.”

I think you get the idea. Is it any wonder we’re all half crazy trying to care for patients in a compassionate and responsible manner, with all these sharks circling around us?

Comments

  1. #1 emmy
    August 6, 2007

    That is insane!

  2. #2 B
    August 6, 2007

    Oh God, I am so going to be busted for lousy record-keeping in a malpractice suit should I qualify…

  3. #3 David Loeb
    August 8, 2007

    You have hit on one of my biggest pet peeves in medicine: the chart has ceased to be a tool for communication between health care providers and has morphed into a defensive weapon in the ongoing fight against malpractice attorneys and health insurance auditors. When I was in medical school, I was taught that the purpose of writing a progress note was to document my thoughts about the patient and to document the important aspects of his care. These days (and it’s not like I’m all that old, thank you very much…), the purpose of a note in a chart appears to be to prove to skeptics that I was personally involved in the care of the patient (meaning the resident didn’t just go off and write chemo all by himself). The sea change in documentation is depressing to me.

  4. #4 Trapped wind
    December 15, 2007

    Ya these kinds of Things generally happens in profession. I had also tackle such kind of problems in my experience.

    Dr. Doniv

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