Good Save

If I ever have to call a doctor in the middle of the night, I hope I talk to one like Dena Rifkin. Forgive me for quoting the NYT at length, but this is what real practice of medicine should be…

The voice on the phone was authoritative, even brusque. A father was calling our after-hours line to ask about his teenage daughter.

“She’s got another headache,” he said, as I recall. “I’m going to the pharmacy, just wanted your advice on what strength of Tylenol to get her.”

Those opening lines did not admit much room for questions. I knew neither him nor his daughter, but there seemed to be little margin for error in my response. I could almost hear his foot tapping, waiting for the answer.

I hesitated. Who is this young woman? Why is her father calling about a simple headache?

I began to ask questions. Yes, his daughter had headaches every now and then. No, this one seemed a bit worse, that’s all. He wouldn’t even have called, but he wasn’t sure if Tylenol was safe, now that she was breast-feeding.

Breast-feeding?

Yes, yes, there was a new baby, just a few days old. Yes, there had been some problem with the pregnancy and delivery — something about blood pressure — but she had come home just fine. Could I just tell him the right dose?

I sent the young woman and her father to the emergency room, and she was admitted to the hospital with severe pre-eclampsia, a rare but life-threatening postpartum complication.

Read the rest, here.

When doctors are tempted or pressured into covering more patients than a reasonable person should, and nurses are spread as thin as cheap margarine you can bet that people die because there is no time to ask the right questions. The human connection can’t be replaced by all the computers and paperwork in the world. Cutting expenses– that is, wages– is good for the bottom line, but understaffing and overloading burns out workers and cheats patients.

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