I did in-patient rounds with another Internal Medicine doctor, Dr. Abbott. Very cool guy and I can’t tell if he is in the group of very dissatisfied doctors here, but he is planning on getting out in a year. He never placed his opinions so out front as some others have. He is another DO, so it was nice to talk to him about his DO school in Arizona.
In-patient care defiantly seems up my ally. When I envision myself as a doctor, I think of doing in-patient stuff, so it felt good doing the rounds today.
Doing the rounds was awesome, but our patients were not. For the first patient of the day I was not allowed to go into the room by request of Dr. Abbott. This patient, an older lady with lower abdominal problems, lives in remote Alaska, and is a dependent. She was already has chronic lower abdominal pain that was being treated with physical therapy and long acting narcotics. Every X-ray and blood work done on her comes out fine, the doctors are not sure what to do with her, but she just keeps complaining about chronic abdominal pain. Well, she shouldn’t be in in-patient care, there is no need for her, Bassett was just a hotel to her; she should be seen during out-patient hours. Originally she wanted to go to the public hospital in Fairbanks, Fairbanks Memorial Hospital, but the hospital suspected narcotic abuse and would not admit her to patient care. She complained and demanded to be transferred to Bassett. A five minute ambulance ride later, she is transferred to Bassett.
When you have a patient with long term pain, many different issues arise. The main concern that the doctors at Bassett and FMH were focusing on is her psychological state. All of her labs are fine; she is given narcotics for pain relief. The question that comes up is how stable is her mind? It’s hard to separate what problem came first, the constant pain that then affected her mind or did her mind create problems to further the abuse? What is easier for a person to obtain oxycontin, buying it illegally on the street, or complaining persistently to a hospital that must admit you?
While this is not an every day case, there are people like this at every hospital region. Right now there is a big push for some sort of socialized medicine in the US. How is the US going to tackle these pain and potential narcotic abuse questions?
Another patient I will write about, 29 year old woman who is in a vegetative state.
