• 'You will urinate very soon.' The paradigm is shifting. In the old days it was a
huge nursing taboo to discharge someone before they actually voided.
Nowadays, it is a common practice. For the most part there are usually
no real issues here unless the patient has a prostate the size of New
Jersey, is on industrial-strength Flomax, has been given enough mor-
phine to sedate King Kong, sees his urologist more than his wife, has
the last name 'Foley' and has a favorite wine named '14 French.' Alert
the on-call team for the 1 a.m. distress signal!
• 'The doctor will call you tonight.' Last, but not least, patients seem to be sent
home so rapidly that on occasion, when the surgeon finally makes it
out to the recovery room, the patients have departed. This is particular-
ly true for surgeons who run 2 ORs. By the time the case in the second
room is complete, the patient is a la casa. In an effort to ease patient
and family concerns, nurses regularly assure the patient that 'Dr. X will
surely call you later.'
This is OK, but I like to do my talking in person. The number given
belongs to the 90-year-old grandparent with 2 magnum hearing aids. It's
hard to show arthroscopic surgery pics over the phone unless I do
FaceTime. It's even harder to articulate the unforeseen difficulties of the
case by phone when I hear "Dancing With the Stars" in the background.
Throughput vs. kaput
Thank heavens I have the blessing of a very responsible and moral
nursing staff. I hope they can continue to hold out against the tsunami
of increased throughput. In the meantime, I do advise my patients who
may be prone to prostatic hypertrophy to see a urologist pre-op!
OSM
Dr. Kelly (johndak4@gmail.com) is an orthopedic surgeon/ sports-shoulder
specialist who practices in Philadelphia, Pa.
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