Who Is Responsible?

But doctor, ultimately it is your responsibility.

I can hear the case coordinator clicking her fingernails against the desk through the telephone line. I admit, I forgot to specify to the nurse, when she called me ten minutes before midnight, that this was a full admission and not an observation. In the absence of my order, a nurse manager reviewed the chart and decided that the ninety five year old woman with congestive heart failure and positive cardiac markers was appropriate for observation status. Of course the order can be changed, but one day will be lost. She will have to stay in the hospital an extra night in order to qualify for the nursing home.

But doctor, ultimately it is your responsibility.

The physician on the line doesn't actually practice medicine. He gets payed by the insurance company to sit behind a computer all day and talk to clinicians like me. I wonder if he knows what it feels like to push on a belly and suspect catastrophe. I do. And occasionally I order a stat cat scan on a patient who is writhing on my examining table to rule out such horrible things. Apparently I should have done a plain film first before moving to a cat scan. Maybe then the CT would be paid for?

But doctor, ultimately it is your responsibility.

The coding and compliance people are reviewing a dozen of my outpatient charts. Some are over coded, some under coded. Occasionally my ICD's are all wrong. It's funny how the quality of care means next to nothing. The dictates are quite clear. Follow these inane and often opaque rules, or get fined. Or god forbid even worse, you might just find yourself in jail!

It's no wonder, I slink out of the office most days with my head hanging low.

For me, medicine is oxygen. It is the bread that I nourish myself with, the draught that quenches my thirst. I have dedicated myself to no other master with such faithful resilience. I have stood on the mountain of knowledge and suffocated on the precipice of my own incompetence. Slept for minutes instead of hours. I battered and bruised my body in the most unhealthy ways. I have been cowed by the humility and shear fear it takes to be responsible for the lives of my patients.

But nothing, nothing is as utterly demoralizing as being told, day in and day out, how irresponsible I am.