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Do you ever get a Christmas card from patients?

The Happy Hospitalist was determined not to be bullied into ordering an unreasonable therapy for something that wasn’t medically indicated. As a result, the patient asked for his name – and he doesn’t think it’s going to be for a Christmas card.

The Happy Hospitalist is a board certified internist who works in the hospital and writes regularly on several blogs, including The Happy Hospitalist.

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Sometimes I find myself deep in battles that aren’t worth fighting.  Patients who are angry, belligerent, and agitated who have the capacity to make sound medical judgments, but chose not to play nice.  Sometimes I run into patients with chronic disease who demand therapies which are unreasonable and irrational in an inpatient hospital setting.

Take for example the 26 year old type one diabetic admitted by a surgeont for an overnight procedure.  She spent the last few years managing her diabetes with a pump, a pump removed during surgery.  I don’t know why they are always removed, they just are. Well, for whatever reason, the pump could not be reimplanted after surgery, so Happy and his gang were asked to see for “elevated blood sugar”.

Of course, after battling with the nurses for two hours, I show up to see an angry patient demanding to get every  30 minute  injections of fast acting insuling to replicate the insulin pump, while she’s here for the next 12-24 hours.  I calmly explained first of all that every 30 minute accu checks were not a rational solution to the issue at hand. Â  I explained that we simply do not have the nursing staff to provide something that is not necessary nor medically indicated.  And the services could only be provided at higher levels of care, which were not medically necessary.

I also explained my doubts as to the medical rational for giving every 30 minute bolus injections of an insulin that is injected every three minutes by pump. Why not give it every hour?  Perhaps every 10 minutes?  Maybe every 2 hours?  Or every 4 hours? I explained that the kinetics  of every 30 minute administration in the next 12 hours of hospitalization were not equivalent to an insulin pump.

I offered to give her a bolus injection of 1/2 her daily basal requirements as a long acting insulin, as she feared being overdosed (despite the post surgical rise) and to provide meal based accu checks as warranted with carb counting and sliding scale requirements as necessary.

Nope.  Nothing doin’.  Anger and agitation was all I got in return.  So I said it’s my way or else risk going into ketoacidosis.  I was not going to be bullied into ordering  an unreasonable therapy for something that wasn’t medically indicated.

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Then she demanded my name.  Here you go ma’am.  It’s Happy Hospitalist, MD.  I guess I’m not going to get a Chrismas card from this one.  I guess you can’t please everyone every time.

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