Thursday, March 11, 2010

Hold, please...

Time for a rant.

When you call a hospital's main line these days, while you're waiting to be connected to the department you want, they don't play muzak anymore; what you hear is instead some testimonial or advertisement about the wonderful greatness of the hospital you've called. At Memorial Hospital we offer the highest quality care, the latest fancy dancy machine/robot...blah blah blah. For a while, my hospital was touting the miracle of the DaVinci Robot on its pre-recorded hold message. I think every hospital in the country that invested in the Da Vinci has that one. The last couple of weeks, however, I've heard messages that sort of stunned me.

The first one was a pronouncement that my hospital now is being covered by "highly trained pediatric surgical specialists to provide the highest quality of care for your children." Pediatric surgeons from a certain monolithic medical conglomerate are now covering ER calls at my hospital. And I ask myself: why? Prior to this development, all pediatric surgical cases went to the general surgeon on call. Basically this meant that we did a lot of lap appendectomies and drained soft tissue abscesses and took out the occasional gallbladder in an obese 17 year old. You know, bread and butter surgical stuff. How exactly does a pediatric surgeon add anything to the mix? Now don't get me wrong I can appreciate what a pediatric surgeon can do. But my hospital doesn't even have a NICU or a PICU. We just don't have the ancillary capabilities to take care of kids with congenital diaphragmatic hernias or pyloric stenosis or malrotation cases. It just doesn't make any sense from a medical perspective. From a marketing perspective, though, it makes all the sense in the world. Now you can go to the community hospital when your kid has appendicitis and a specialist will be available to remove it. How about that? I mean I get it. I just think it's misleading and disingenuous.

The other hold message was one proclaiming our designation as a level II trauma center, but the way it was phrased gave me pause. The voice intoned-- "this is the 2nd highest ranking a trauma center can attain." What the hell does that mean? Is this some sort of BCS system? Are we ranked 2nd in the AP and 3rd in the coach's poll? It's absurd. It isn't a ranking. It's just a way to communicate the level of trauma care a hospital is able to provide. Level one trauma centers have attending trauma surgeons in-house at all times. As a result we can quickly funnel most major traumatic injuries (gunshot wounds, complex pelvic fractures, etc.) to the appropriate facilities.

Anyway, I just hate the way marketing has infiltrated the practice of medicine in such a way that it obfuscates the true meanings of words and concepts.

11 comments:

rlbates said...

I so agree with you on marketing has infiltrated medicine.

Anonymous said...

what about that rare appy in the under 10 crowd? what about that air enema for intussusception that perfs? What about the foreign body endoscopy?

seems like having peds surgery coverage around would be a good idea, even for a community hospital with no PICU.t

Buckeye Surgeon said...

Anon-
All the general surgeons here do lap appies on kids less than 10. The anesthesiologists hesitate for kids under 5 so sometimes we send those to the Children's hospital.

And air enemas are usally done by pediatric radiologists. And foreign body extractions can be done by either a peds Gi or peds surgeon. But it's a rare enough event that you can hardly justify creating a dept of pediatric surgery just to retrieve marbles from some kid's esophagus.

BR Morrissey said...

Looks like you'll just have to increase your strength of schedule next year if you have any hope of becoming Level 1.

Anonymous said...

"All the general surgeons here do lap appies on kids less than 10"

wow, that's surprising but cool. No offense but the peds surgeons have brain washed me and I think I might drive the extra hour to get the hospital with the ped surgeon if my kid had RLQ pain.


The intussusception comment was referring to the ones that perf or fail after the radiologist tries. our peds ED had one perf this last month. Aside from that specific example, it just seems like we get surgical abdomens in our peds ED almost every day; half the time it's not obvious the kid needed to be rushed to a tertiary care center. I'm just saying broad access to peds surgeons is a very good thing.

Frank Drackman said...

Gotta agree with ya Buckeye..
Y'know the hardest part of Pediatric Anesthesia?? Workin the dials on the tiny little anesthesia machine....
Seriously, all you have to do is multiply all your adult doseages by whatever fraction of adult weight your tiny adult is...
its like 5th grade math, 10mg is to 70kg as "X" mg is to 7 kg
Cause Children really are just tiny adults,
Oh yeah, don't use Succinycholine on kids unless you really have to,because of the risk of ummm...
umm, something really bad can happen.

Frank

ER's Mom said...

I'm so tempted to place an ad in the local paper touting my "single incision hysterectomy!" and my "scarless hysterectomy!"

After all, an old-fashioned vaginal hysterectomy uses a single incision. The scar is not visible (to most people)...

;)

tom said...

When health care became a commodity the "need" for marketing uniqueness followed. I would be more interested in data on infection rates, deaths, ALOS, etc After all what good is "special' if the outcomes are lousy

Brian and Jennifer said...

It's just a way for the Evil Empire and their 168 acres of prime Downtown property to retain a greater amount of control over what happens in the medical universe, in preparation for the shiny new hospital opening up 3 exits down the road.

Victor Lazaron said...

I have never sent a kid with an appy out of my little hospital - ever.

Doing an appendectomy in a child is just like doing it in an adult - only easier.

Anyone who thinks a kid with an appy (or a kid with a hernia) needs a peds surgeon is really drinking the koolaid. Unfortunately my local pediatricians think this about hernias - thats why i get so few of them, and they are SO fun and easy to do.

susan said...

Amen