PART 2 (of 5) Click Here for Part 1
How does your hospital stay involve politics you ask? I’m getting to that, I promise. Let’s follow your admission from the time you enter the ER with a list of complaints. The ER does an intake history on you where they list all your complaints and concerns. If you get admitted, you have provisional diagnoses for these complaints as well as your established medical ailments. As I said, you get admitted to a Hospitalist, whoever is on call for the ER that day. The Hospitalist is most often a recent graduate of an Internal Medicine residency program who has never left the hospital. This means they go from being a physician-in-training to being in charge of your care without any real world or office experience.
At this point you’ve given your list of regular medications to the ER staff several times already and you assume that this list of medications would make it to your admission records. You would be wrong. Since all hospitals have to have electronic medical records to comply with CMS guidelines (in spite of evidence showing increased medical errors) the Hospitalist has to “accept” and “order” your medications in order for them to be continued. These orders are one of many on several screens that have to get “checked” and “signed” and so on. The screen shots are like computerized Jackson Pollock paintings. If you don’t know who this is, google him. Furthermore, hospital pharmacies have medication substitutions for common ailments so you may not get what you actually take. This is of course a money saving measure. While some medications really are interchangeable, that isn’t always true – especially if you have an allergy. Typically physicians are on the formulary committee making this decision, but not always.
Now you are safely ensconced in your room where the nursing staff begins to minister to your needs. Much of their care is dictated by protocol and it seems there are protocols for everything. They have to check a myriad of boxes on the computer screen to make sure administration knows they are following these protocols. The Hospitalist will see you at this point if they didn’t see you in the ER to discuss the plan. Of course you assume that this involves testing, blood work and maybe even a procedure. You may also assume that you will likely have a consult with a specialist or two to review your case. In fact, you may have chosen a hospital where your own specialists already have a relationship. This of course you’ve told to the ER and the Hospitalist when you were admitted.