Thursday, November 29, 2007
Efficient use of resources
Another classic example of the wasteful nature of the American way of providing medical care. An elderly lady came into the hospital last week with three days of severe RUQ pain. An ultrasound done in the ER suggested a dilated gallbladder with peri-cholecystic fluid and a positive sonographic Murphy's sign, but no gallstones. She was admitted to the medical service. A GI consult was obtained the next day. A CAT scan was ordered. Again, the imaging suggested edema around the gallbladder. She had a WBC count of 15k. Her hemoglobin was 12 (slightly anemic, technically.) So a surgical consult was obtained, right? Hardly. She was bowel prepped and underwent upper and lower endoscopy. Of course, the ubiquitous "antral gastritis" was diagnosed and she was immediately started on IV Protonix. Unfortunately, she continued to have RUQ pain (can you imagine, despite the protonix?). Cardiology was contacted but troponins and ekg's were negative. The next day a HIDA scan was obtained. This demontrated non-filling of the gallbladder up to 6 hours. At 5pm, my office received the consult for this poor lady. It hurts right here doctor, she said, pointing to under her right rib cage. The next morning she underwent a laparoscopic cholecystectomy, with severe inflammation of the gallbladder noted. She was in the hospital three days before a surgeon saw her. Multiple radiographic tests were obtained. Invasive procedures were performed. What is going on here? I'd love to see her hospital bill and tally up all the unnecessary work that was done. Multiply this case by the surprisingly numerous times similar patients are managed you'll find a gigantic sinkhole into which much of our health care dollars are lost.