The ambush

November 4, 2005

His desire to help others compromised his judgment and taught him a valuable, potentially life-saving lesson.

It was unusual for me to go to the hospital in the morning, since in-patient medicine isn't a large part of my practice, but I knew it wouldn't take too long to see just one patient before heading on to the office. I greeted the nursing staff and then walked briskly to my patient's room.

Mrs. Hughes was suffering from a severe lack of attention from Mr. Hughes, as well as an exacerbation of her emphysema and diabetes. Odd how oxygen and nebulizers work so much better in a hospital than they do at home. I stood outside her door pondering my approach. Do I emphasize her excellent saturations and normal sugars in the hope of empowering her to be discharged and returned to the not-quite-nurturing but certainly competent oversight of Mr. Hughes? Or is her wheezing, persistent cough and mildly elevated white blood cell count important enough to require another day of coddling?

Outpatient-only doctors may scoff, but it's a tough call. If you discharge the patient before she's ready-whether that state of readiness is physical or emotional-she may "bounce," or be readmitted, within 30 days. Too many bounces result in no end of consternation from the hospital's utilization review nurse.

"Dr. Switzer, are you busy?"

I turned and saw Mandy, one of the hospital employees, standing beside me.

"What's up, Mandy?"

"Well, my daughter, Brooklyn, has had a croupy cough for a week and it isn't getting any better. What do you think I should do?"

"Did you call the office so I could see her later today?"

"Well, I was hoping we could just try that medicine you gave her last time? Could you call that in to see how it works before I bring her in?"

"Which medicine was that?"

"Oh, I can't remember. But it's in her chart. Can you just do that first, please?"

An ambush can happen almost anywhere. I've been ambushed at the gas station, at the local coffee house, and outside the supermarket while trying to get two fussy daughters into the car. I've even been ambushed in the parking lot of my clinic by a patient who had an appointment to see me 20 minutes later.

The common factor among all ambushes is that the doctor's concentration regarding a patient's care is overshadowed by something else. It is the perfect setup for bad decisions, since the human brain can only give its full attention to one matter at a time. Instead of concentrating solely on Mandy's daughter, I was focusing on whether or not I should extricate Mrs. Hughes from the hospital setting.

I glance at my watch out of the corner of my eye. Do I argue? Or just take the path of least resistance and say Yes? I choose the latter and agree to call in a prescription. She tells me which pharmacy she uses and thanks me profusely.

As Mandy leaves, I think to myself that Brooklyn just received some rotten, ambush-related medical care. I had not seen the patient. I had not reviewed her chart. And I did not specifically recall "last time." I was guided by my desire to swiftly make both the daughter and mother feel better; unfortunately, I did not succeed on either count.