Medicine is fun!

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.


6 responses to “Medicine is fun!”

  1. Russell

    OK, I’ve thought about it. My conclusion is that I should do as much as practical to avoid the need to be admitted to a hospital. 😉

  2. azqaz

    Well, Russell, the way I see it you can listen to people like PalMD, MarkH, and your personal physician and you will spend a lot of time in the hospital when you are in your 60’s, 70’s, and 80’s. Maybe even your 90’s. If you really don’t want to spend time in the hospital, listen to the cranks that show up as the focus of many of their posts and you’ll be dead in your 50’s or 60’s thus missing out on LOTS of hospital visits. 😉

  3. This is certainly true and it will only get more pronounced. Even with this increase in “sickliness” a good number of stays are still considered “weak”. A study in Pediatrics month looked at every admit in two six month periods at Toronto Hospital for Sick Kids (May to October in 05 and 06 I think). During the first 6 months 47% of the days were deemed non-qualifying (hospital stay was not medically justified given community resources like home IV etc.). The next year they looked at the same 6 month period but added an intervention component where the admitting doc was gently confronted regarding the appropriateness of the hospital stay. Their rates dropped to 33% during the intervention phase. Interestingly, there was no statistical difference in “bounce-back” rates when comparing the two six month periods.

  4. I’m curious about the reasons why hospital admissions are sicker than they used to be. While I accept your explanation at least partly, is there also the possibility that in some way this represents a failure at the front-line?

    I wrote quite an in-depth article about Cuba’s health system recently. It isn’t as good as some people claim (particularly if you’re not a tourist), but they have a very good policy of using preventative medicine. I’m just wondering if a similar policy in the States (or the U.K., but obviously you don’t live here) would have an effect on the “typical admission”?

  5. Mongrel

    I would also wonder if age is a factor as well.

  6. Denice Walter

    Patients in hospitals are SICKER than ever before! (What a great headline for some altie journal or website)And they’re sicker because of:( fill in the blank with the usual alternative explanations).Oh Pal, be careful, those words might be traced back to you and used in an article about a quackbuster “telling all” 😉

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