By Kelly O’Brien, MD, FACP, CCHP
Posted on April 15, 2009 – The Health Services administrator comes through humming. Crunching numbers again, she thinks if they all work together, they can satisfy the County contract and keep their accreditation. An LPN here and there and these new psych meds- my goodness! Can that many people really need psych meds? Surely they can cut back on those. After all, suicide rates are down now. And that one doctor handing out ibuprofen like it’s candy. Buy it on commissary, for heaven’s sake. It’s available twice a week. Good morning she lilts as she cuts through the exam room. Ah. The Motrin Pusher doctor, one of the officers, and an inmate. Oh wait—down here we call them patients. I brought donuts for our meeting later today. We’ll be doing some strategizing for our new staffing plan, looking at a CQI project [she loves these terms—so businessy] and updating our mission statement [could she please just fit in ‘paradigm shift’ and her morning would be complete.] She watches while everyone is engaged in the task at hand.
The physician is once again weighing the risk/benefits (actually cost/benefits since they’re over budget, again.) This guy’s arm was broken 2 weeks ago, at work. He was arrested two days ago, and last night pulled the cast off up in his cell. Now the officers have sent him down to get it checked. The patient hems and haws about why it’s off. He finally said he couldn’t really do push ups with it on. She stares at him in amazement—can this be true? Are some people born without even a small part of cortex dedicated to decision making? Before she generates an appropriately edited replay, the officer snorts derisively and shakes his head. Oh, this is helpful— we need more testosterone in the room. Sure enough, the inmate withdraws his arm, won’t answer anymore questions and makes a suggestion of anatomical difficulty to the officer. She rolls her eyes. They’re both idiots.
The officer was up late with his kid again—and another trip to the ER. He had to cover the co-pay and go get different antibiotics. Jeez. What a scam. Now he has to take this punk to medical, and the kid’s whining the whole way down that he didn’t kite, and he doesn’t want to pay the seven dollars. Seven dollars! Why do criminals get $7 co-pays and people like him, who’ve never been in trouble and have a job, can barely afford to get seen. Now the doctor’s all nice to him and being all sympathetic. He took off the cast himself—how much sympathy does that deserve? At first he wanted to help the kid, but now he’s fed up with the whole thing. He rolls his eyes. They’re both idiots.
He knows doctors do things so they can overcharge you. His grandma was sick when he was a kid, and they always had to go on the bus, and wait at the clinic and pay money, and the doctor would tell her some stuff, and maybe take some blood. He never really made her feel better but he’d always tell her to come back in a couple weeks, even though she couldn’t afford it. So his arm hurts and maybe it’s broken and maybe it’s not but that urgent care doctor told him not to work, showin’ what that guy knows. He’s not at some desk job where you can just take off and get paid for doing nothin’. He won’t even have a job to go back to if he takes off. Now those clowns in the cell looking at him funny, and he better look like he can take care of himself so that cast was coming off. Tried a few push-ups to see how it felt. ‘Sides, he wants those guys to see he’s strong and his arm is no problem if they’re gonna do anything funny. Now this doctor’s talking all fakey sweet trying to figure him out, probably the damned psychiatrist, and studying on his arm like that alone will make it better. And that guard’s bein’ a jerk, and it’s not his business anyway. They’re both idiots.
The HSA looks around, pleased with what she sees. Well, isn’t this great— working together. We’re all thinking alike! She heads off to find some special colored markers for the meeting.
Dr. O’Brien is an SCP member and physician with Denver Health and Hospital. Readers may contact her at kelly.obrien@dhha.org.
