Plan Good Discharges

Jeff Glasheen, MD

It was probably just the ramblings of a mad woman. Only she wasn’t mad, so I searched for a hint of delirium. Nothing. She was mentally fit and lucid—perhaps too lucid. Could it be true … had I become my archenemy?

To decide, I put her utterance to the test through the Kubler-Ross obstacle course, hopping the denial hurdle, quick-footing through the anger tire course, wading through the bargaining pool, and finally swinging safely across the depression crevasse to acceptance.

She was my eighth patient that day, a 78-year-old woman admitted to the orthopedic service with a hip fracture. I was asked to do a preoperative risk assessment and comanage her diabetes and heart failure. During our introductions she asked what kind of doctor I was.

Habitual tardiness, sketchy response times, vague payment structures, lack of transparency in pricing, pricing errors into the cost of the job—I don’t think the analogy was intended to be so perceptive. I and the healthcare system within which I work really had adopted some of the less-desirable attributes of the contracting world.

“A hospitalist,” I replied.

“Oh … that’s nice,” she answered, her furrowed eyebrow transforming her crow’s feet into a question mark.

“You know, a doctor who only cares for patients in the hospital,” I clarified. “I just take care of your acute problems.”

“You think a broken hip is cute?”

“No, no, not ‘cute.’ Acute. You know, I only deal with your urgent problems. When you leave here you will go back to see your primary care doctor, who will follow up your hip fracture and your more chronic issues.”

That’s when she dropped the bomb.

“Oh, I see; you’re sort of like a contractor for my body then—just helping when things get broke.”

I should explain my aversion to this comment. Reared by a 10-thumbed father, I’m genetically incapable of curing even the simplest household hiccup. This doesn’t mean I haven’t or won’t try. In fact, I’m willing to try anything. My wife, however, is too smart to allow that. She knows that home improvement project plus me equals larger home improvement project. Combine this mathematical axiom with our turn-of-the-(20th)-century home, and it’s easy to see why I find myself betrothed in nearly continuous engagement with contractors.

But this is a marriage on the rocks. As dependent as I am on home contractors, I generally dislike working with them. They’re all fine people I’m sure, and truth be told most of them are quite skilled at their work. The problem is that they go about their job as if they are allergic to customer service.

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