Wednesday, November 23, 2011

Why Do We Do It...?

Some days it feels like this.  You work hard to try to help someone, and they burn you.  Humph, just made a funny.  You see, we had a young patient with severe burns this week.  They'd been working on a piece of machinery which caught fire burning their hands and their face.  They had to go to a burn center.  We have a limited amount of resources in our small hospital.  We're not prepared to take care of 3rd degree burns to the hands.  Our surgeons aren't experienced in doing skin grafting and managing the long term complications of wounds.  Especially to the hands.  Especially in a young person.  So we need to rely on other specialists taking our patients.

Not to mention we live in a secluded area.  The closest large cities are several hours' drives in any direction.  Medford, Redding, and even Sacramento are almost 5 hours away.  San Francisco is about 5 1/2.  So most of our transfer patients are flown.  That involves a flight crew that has to come from one airport to our closest airport and then they need to be driven to our hospital.  So they're taking a risk just in the journey to get to us, not to mention the journey to the receiving hospital.  They don't fly in a helicopter, they fly fixed wing.  So they can't just land at the hospital.

We take the time to make phone calls.  Another physician has to accept.  A patient from our hospital can potentially mean that another patient, perhaps even more severely burned, can't be accepted due to space.  Now you have a flight crew that has to travel via ground and air then ground again to get the patient.  They then repeat this process three more times to collect the patient, deliver the patient, and then get themselves back to base.

And, after all that, the patient signs out AMA (against medical advice).  Why, you might ask?  Because the hospital wouldn't let their significant other sleep in the same bed.  Because the hospital wouldn't allow them to smoke whenever they demanded.  So they left.  Without follow-up.  Without antibiotics or pain medications.  Without instructions for continued care.

That's the society we've created;  an on-demand, according to my schedule, give me what I deserve kind of mentality with no sense of responsibility.  Our hospital isn't going to collect anything on this patient.  The flight service isn't going to collect anything.  And the receiving burn center isn't going to collect anything.  Resources have been spent that could easily have gone to help many others have been wasted on those that don't appreciate it, and who will now not have the means to contribute anything back.

You see, those burns aren't going to fix themselves.  A few short weeks of treatment could mean the difference between a person working or being so disabled as to not being able to dress themselves.  I'll be seeing this patient again: for their chronic pain, chronic disabilities, chronic complaints that "they didn't do anything for me and ruined my hands".  And, we'll all be paying for it in the long run.


1 comment:

That corgi :) said...

And that is why you document, document, document everything so when he comes back people can see he refused treatment and signed out AMA. Sad that he did. Geesh for silly requests too. You are so right though, an entitlement generation we have these days. Just so sad!

betty