In adult medicine, we talk about ownership. Of patients. Ownership of patients. Who "owns" the patient. A term which we use to bring a sense of personal responsibility to taking care of our patients.
On Friday, as I was sitting at the pedi graduation party, there was a comment made about how taking care of children is a special privilege and that children are the most important thing in the world to their parents, so when we take care of kids, we should not go about our job lightly.
To me, these are the same issues-presented in different contexts. It's about realizing the significant role we play in the lives of others, and the responsibility we have to provide the best care to those whom we serve.
I strongly believe in taking full responsibility for patients.
Patients
in
the
hospital.
At 4:30pm I logged on to the computer, and a message popped up. In my mind I was already out the door, trying to figure out where I was going to go get my haircut. But I had 2 orders to enter, and when I logged on, I noticed I had an inbox message. I let out a groan, assuming this was yet another medication refill request, and debated leaving it til tomorrow.
But the Aquarian curiosity got the best of me and so I opened the message.
RT was in the ER. And then things ground to a halt.
Four hours earlier, I had gotten word that RT was going through hell. His mom had called because she was very concerned about him. I had never met RT, but I am his Primary Care Physician. For over a year, I have been his PCP. And I have never met him, and now he is in crisis, in the ER, and I am his doctor-but only for 4 more days and what the hell do I do???
I believe in ownership.
He came to the ED because when I heard what had happened that nauseated-gut-wrenching-ill-feeling hit me, and I I was bound and determined to help my patient. At some point, a paternalistic-physician mentality takes over, and there is an outreaching to help. It's the core value of my profession. I scrambled to figure out who would be able to track down RT and make sure he ok.
I found him in the ED. It was easy. His bloodshot eyes showed the strain of days of tears.
I introduced myself.
"You're my doctor." He looked surprised to see me. Which was fair.
"Yes, I am. We've never met. But I know who you are, and what's been going on, and I came to meet you personally, at last."
I'm here because of guilt. I don't take ownership of all my patients in clinic. There are ones I know well, and I think I take ownership of them. But there are many, many more I don't know well, who I may see once a year, or have maybe met once or twice in 3 years. And there are those who are "assigned to me," and quite frankly, I don't have any clue who they are. RT and his partner (JT) were assigned to me over a year ago, but I have never met them; their infectious disease doc managed most of their needs. Managed their ID needs. But as their PCP, I am responsible for managing their health, which includes their mental health. And knowing that JT committed suicide a few days ago leaves me feeling like I failed to live up to "ownership." RT and JT were assigned to me for a reason, and knowing that I did not live up to my own standard of taking special care of, and interest in my gay male peers compounds this feeling of failure.
And there I sit looking at a broken soul.
We talk. There is a total lack of privacy sitting in the hallway of the ER, but oddly the rest of the world seems to go silent as we talk.
I have gone into denial about what will happen when I am gone from the clinic for a year. I don't ask what will happen to my patients. I have taken a leap of faith that somehow "The System" will work and that my patients-those who I own, and those who are assigned to me-will be provided for in the year to come. But sitting, talking to RT, I realize that blind faith is a lousy plan.
I tell RT how he can get in touch with me, day or night. Fuck the system.
Today is a failure of patient ownership.
I know full well that the events that have happened were going to occur regardless of if I had ever met JT, but today serves as a reminder that I have a cadre of patients, whom I can serve better than my co-residents, and that ownership should extend equally to the outpatient world.
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