Inpatient Medicine

In the morning, we round on patients and monitor their progress. In the afternoon, we make phone calls to track down patient records, call primary care physician offices to schedule follow-up appointments, update other physicians on the progress of their patients, and on top of that try to deal with the myriad of social issues that inevitably arise with our patients. In the morning, we do what most people would imagine a doctor to do. In the afternoon, we do all the crucial busywork in an attempt to ensure some form of lasting continuity to whatever clinical improvement is made during a patient's stay at the hospital.

The term that keeps coming up in the hospital in reference to some of our patients is the word "babysitting." We make calls to their doctors when they should be doing it themselves. We repeatedly try to convince them to take their insulin when they complain they don't like getting shots to prevent one or more of the innumerable consequences of diabetes. For all the complexity that goes into learning about obscure diseases and the latest evidence based medicine, playing the social game is often just as difficult and a hundred times more draining.

It would be easy to blame all of this on patient lack of education, but the reality is that the messiness extends to all levels of society. Richer people may be more knowledgeable and compliant (and even this isn't a guarantee), but this does not always guarantee gratefulness or the ability to cope with dire circumstances. The mix of uncertainty, anger and denial will make the most educated person irrational--and all it takes an already stressed-out intern or jaded senior resident to turn a normally workable situation into an intolerable one.

It is this afternoon work that often drives many residents to do everything they can to avoid the social mess that is the modern health care system and pursue careers in outpatient specialties or more surgically oriented fellowships. After all, why should one go 200K in debt to subject him or herself to rude patients, patient who won't take their medications, chronic drug abusers who abuse the health care system as much as they abuse the drugs, and have to spend hours calling hospitals just to track down some test that was done 5 years ago that may not even end up being useful in the end? Why wouldn't you want to go into a field where you can dictate the patients you see and only have to deal with patients who actually want to see you?

Inpatient medicine is not merely Patient X has Disease Y that must be diagnosed by test Z and treated by drug 1 or Surgery 2.

No, it is much more often Patient X with disease Y will not take Drug Z for his condition Q which causes him to come into the hospital with complications A,B, and C leading to hospital stays that require expensive testing 1,2,3 that are ultimately paid by the taxpayer because Patient X is on Medicare or unemployment.