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Can you ever be too safe?

November 2010

I can report from experience that one’s heart skips a beat when told that his mother is in the emergency room. During that split second between when the news was first delivered and the reason why was fully explained, my mind raced like Google’s search engine. In 0.19 seconds, I had processed at least 100 possibilities and none of them was good.

Fortunately for me and my mother, the account quickly turned comical. “Son, your mother accidentally took the dog’s thyroid medicine instead of her own.” OK, that is funny, especially when–I was relieved to learn–the dog was taking a pill only eight times as strong as my mother’s. Who knew, other than veterinarians of course, that dogs require so much thyroxine?

But this blog is not about the trials and tribulations of the DeLue family or their thyroid-deficient pooch, even though I firmly believe we might be a bit of an outlier when it comes to having reasons for telling good stories. Did I mention the time we accidentally set that same dog on fire? Fortunately, he was not injured, and I have no reason to believe this sequentially led to his thyroid condition.

What I did want to relay is what happened when my mother called the PPO’s nurse “help line,” asking what to do. The answer: “Hang up the phone and immediately call 911.”

Really? My response: “Are you sure they knew the dose and the number of accidentally ingested pills?”

The folks replied: “Yes. We also told them her pressure was 170 over 80 and she felt a little funny, but that was it. After telling me to call 911, they even gave us preauthorization to go the ER. When we got there, the ER doctor walk into our room and said, ‘Woof, woof, my named is Dr. Rover.’ ”

As hospitalists, we well know the many truths about our daily practice. We are under immense pressure to move people in and out of hospitals as fast as humanly possible, due to the financial concerns of insurers, both private and the CMS.

We know that we must balance that imperative with the need to provide outstanding patient-centered care, along with the occasional concern that early discharge might expose us to a slightly greater malpractice risk. And I believe that we understand the need to walk this thin line more than any other specialty, given how much we appreciate the need to try to bend the cost curve before it collapses.

So what is my point other than to state the obvious and tell a funny dog story?

Point No. 1: I am more than a little frustrated with the insurance company. I realize that this was a singular event and a single receptionist on the phone. But I often speak with plenty of insurance case managers who are pushing people out of hospitals when they are more than a little unwell. To think that no one was willing to tell my mother, “Relax, the dose is 50 times below toxic, just make sure you don’t confuse the casserole with the Alpo and you will be fine” makes me wonder where else they would just as soon offload all risk on doctors while assuming none of their own.

Second: The incident reminds me how risk averse we have all become regardless of insurers’ entreaties to cut costs. We irradiate anything that moves in the ER. When I started my career, chest pain meant pain in the chest. Now, just about any twinge, cringe or ache below the nares and above the umbilicus results in a stress test. I even remember a time when transient compression ulnar neuropathy meant you fell asleep on your funny bone, not that a MRI was needed to rule out TIA. Maybe I exaggerate a little, but really, not that much.

In today’s litigious society, perhaps you just can’t be too careful. Just ask the four-year-old defendant from New York. The preschooler is alleged to have acted negligently when she collided with 87-year-old Claire Menaugh, or so claims Ms. Menaugh’s estate. After breaking her hip in the collision, Ms. Menaugh died from unrelated causes several months later. The lawsuit is still pending, but a judge ruled that the case against the girl could move forward.

So just to be on the safe side, let me state: This blog is never meant to dispense any medical advice whatsoever. If you did just ingest your dog’s thyroid medicine, perhaps it is best that you immediately stop reading and call 911. And please, when you’re walking with your children while they ride a bike with training wheels, make sure you keep them on a leash.