“Harry, do you love me?” “Yes Mabel, I love you.” “Harry, would you die for me?” No Mabel, mine is an undying love.” (M. Banks)

My wife’s mother was hospitalized recently at University Community Hospital in Tampa. She had known cardiovascular disease with increasing shortness of breath, intractable orthopnea with nocturnal dyspnea. The ER physician, the admitting internist, and the consulting cardiologist were unable to make a diagnosis. I personally spoke with the consulting cardiologist suggesting that a little Lasix intravenously wouldn’t hurt, and was assured that she definitely had no CHF. After thousands of dollars of tests, including a cardiac catheterization, he found a “surprising” increased wedge pressure and gave the first Lasix. Within a few hours my mother-in-law had such dramatic improvement that she was able to lean back against her pillow for the first time in a week. That was almost like dying. Would a $5 shot of Lasix by the ER doctor have saved an admission; or by the internist saved thousands of dollars worth of procedures?… Bouncing the scenario off the second year medical students in my office for my annual six weeks of teaching, they had no difficulty making the diagnosis or recommending the appropriate treatment from the medical history. Nice to know that UCD students are smarter than Florida specialists. And more cost efficient.

In that same Tampa hospital, Willie King had the wrong leg amputated on Feb 20. Leo Alfonso had his ventilator shut off on March 2 by a technician when the order was written on another patient. Now, that really is dying (by technician empowerment?). Another patient had an arthroscopy on the wrong knee. My wife made an urgent trip to Tampa to be with her critically ill mother. She was able to interrupt three IV meds that duplicated meds previously given. No meds! Wrong meds! Wrong leg! Wrong knee! Wrong ventilator! Maybe Herb Caen was right, “I think I would avoid having lunch in that hospital.”

Hills Physicians have decreased their specialty/primary care physician ratio from 3-1/2:1 to 2-1/2:1. This is still above the industry average of 2:1 in open groups without walls; or a 1:1 ratio in groups such as Kaiser. The meetings between Darryl Cardoza, the chief operating officer, and the physicians from Sacramento, ElDorado, and Placer counties have identified a previously unmanageable portion of health care as being the open ended cost problem when a primary care physician refers to a specialist and then loses control of his patient. He may think he’s getting a $150 consult and the patient ends up with $150,000 of procedures. This is now managed by keeping the primary care physicians on a fee for service and placing all specialists into specialty units on capitation. Each specialty unit has one chief in the greater Sacramento area who will be in charge and will arrange for educational forums with the primary care physicians. Dr. Bruce Bob, the medical director, indicated that he taught the practitioners in Rancho Cordova how to do endometrial biopsies so they wouldn’t have to obtain a gynecology consult. Despite the “practice pains” many experience, Hills may have defined the “managed care plan” that does the most to retain the primary care physician/patient relationship.

Cal Thomas of the LA Times quotes Pres Lyndon Johnson: “The fight against poverty is within our grasp.” With three decades of the greatest social experiment the world has ever seen with $3.5 trillion in government funds, poverty is more rampant than ever… Maybe we should put the government in charge of fighting disease. We would then have disease so rampant that all doctors, even specialists, would have a job.

As physicians increasingly become like employees, we should look at the problems that nurses are having as employees–all of the risks and none of the rights and benefits. The National Labor Relations Board felt that the supervising which both RNs and LPNs do was intrinsic to their profession and not the long arm of hospital administrators. They should be protected from unfair labor practices like any other employee. The supreme court last year, in a report written by our own Sacramento Justice Anthony Kennedy, struck down this practice. Justice Ruth Bader Ginsburg, who wrote the 17 page dissent for the other four justices, stated, “The court’s opinion has implications far beyond the nurses involved in this case. If any person who may use independent judgment to assign tasks to others or direct their work is a supervisor, then few professions employed by organizations subject to the [National Labor Relations] Act will receive its protection.” It looks like doctors and nurses are already in the same risk group. When we are fired at administrators discretion, it will be almost like dying– professionally.