IV. The patient is the one with the disease

These days, most hospitals have instituted discharge planners, patient support staff, multi-disciplinary rounds, length of stay rounds, all in an effort to save money. And that's admirable, getting efficient hospital care. But what it means to me is on top of my senior and my attending, I have even more people questioning my clinical decisions. This person is an inappropriate admission. This other person doesn't have adequate nutrition. This one needs to go to ECF. I've got so many people riding my ass, I should install bleachers.

The nurses at least are somewhat sympathetic. We're in the trenches, and it's easy for other people to snipe when they're not the one telling the pt with intractible pain that she doesn't meet acute care criteria for admission and here's some vicodin.

And I appreciate the help sometimes. But it's hard not to be dragged down some by patients. It's hard not to feel miserable when you've got a rock garden going (doctor slang. Rocks don't move. A patient who's a rock is one that won't be leaving the hospital anytime soon). And it's only worse when 4 or 5 people who don't have to even lay eyes on the patient tell me the many ways I'm doing my job wrong. But one of the nurses reminded me, with a pat on the back: hey, the patient's the one with the disease.

Thank you, House of God. Your rules have kept me sane.