Well, I’m back from a great vacation, and buried under an avalanche of work. Just to give you a hint of what an internist actually does…
My office schedule is full—really full. Everybody needs to see me, plus the various sick people I have to squeeze in. It’s great; being busy is fun, but it’s time consuming.
Then there’s my desk. It is covered in lab results, home care orders to be signed, hospice orders, medication refills, prior authorizations…
And of course, back to teaching, including evaluations, etc.
So, it may be a bit quieter around here for a while, but I wanted to point out a few interesting things. MarkH is finally getting around to practicing some real medicine, that is, internal medicine, and he has discovered what I love about it—the mysteries (and it ain’t House, folks). One important point in particular he raised is how sick medical patients really are these days:
The more realistic medicine patient would be someone over the age of 50 with at least 5 or 6 chronic problems, and just one (or two, or three) that has put them over the edge requiring hospitalization.
Hospitalized patients are much sicker than they used to be. This may sound a bit odd, but many diseases are now successfully managed outside the hospital. Also, as hospitalization has become more costly, you have to be pretty sick to get in the door. For example, 25 years ago, it wasn’t unusual to admit someone for a “work up” of one kind or another. Now, patients must meet certain criteria of “intensity of service” and “severity of illness” to have an admission qualify for coverage. This usually isn’t a problem, but sometimes it is. Just something to think about.