Uneasy Lies The Head That Wears The White Coat

Hesham A. Hassaballa: This is Healthcare Musings. I'm your host, Dr. Hashem Hasabala. Welcome to Healthcare Musings, everybody. Happy to have you with me. You know, it's happened to me s more times than I care to admit. the bedside nursing colleague in the ICU will come to me and say, Hey, can you come speak to the family in room? Whatever. You know, I told them everything we discussed and everything you said on rounds, but the family wants to talk to a doctor and hear it from a doctor. And so go. And say exactly what the nurse told them. And they they they take it. They they believe and they say, Thank you, Doctor. Now, on the one hand, it's my job to talk to families and give them an update and think what I'm thinking and tell them what I'm doing. There's no problem. I'm not complaining about that. It's just makes me sad that the thing that the exact I can say the exact same thing. That the nurse says, and it's taken better because I have a white coat than from the bedside nurse who is there with the patient much longer than me, is seeing the patient on an hour by hour basis, you know, whose judgment I trust implicitly. And when the nurse tells me something's wrong, it would be to my detriment and the patient's detriment to ignore it. or if I'm not doing anything about it and to explain to my nursing colleague why. I said that we're all on the same page. And and and that's just it's just the way it is, right? That is the it and it reminds me of that line in Shakespeare. I I looked it up, I think it's Henry the Fourth, where Henry the Fourth says in the play, Uneasy lies the head that wears the crown. Now we're not wearing a crown in the ICU, and at the same time, the responsibility of that white coat, it just falls on us. And so Things like this we just we just have to do. and it's it makes me sad that they don't believe it when it comes when I when when a nurse says it, but then when the doctor says it, they believe it, it's even it's the exact same words. That is just the responsibility of being a physician in the ICU. You know, the same with you know, just d doing talking to other physicians and and and seeing all together and and having goals of care conversations and and all those things. it's just the it's just the responsibility of the of the physician and it's and and it it's it's not a it's not a burden, right? I I I I hesit I hate to hesitate to use that word. It's not a burden. It's it's a responsibility. and it's a privilege. And it kind of ties into Last week's episode about one team, one fight, right? when you hear docs talk, it's like, my God, they just, you know, they throw them on BiPAP after five minutes and then it becomes my problem, right? well it's not it's not my problem. It's my responsibility, it's my duty, it's my it's my privilege, right? And so with the privilege of being a physician, and the and you know what? A physician being a physician has a lot of privileges in healthcare. With everything that physicians have lost all the autonomy physicians have lost all the extra work that physicians have to do all the gobbledygook that is piled on to doctors and still at the end of the day there is still a tremendous privilege of being a physician. Billing let's let's go for let's let's think of billing. The billing is based completely on the physician's documentation. That is why they send queries to us. And that's what that's what clinical documentation integrity is all about. It is but the documentation of whom? The nurse? The respiratory therapist? The nutritionist? The physical therapist? The occupational therapist? No. The physician. It It rests on the physician's documentation because the physician is the ultimate head of the care team. And so everything that we do still it's not they now there are some times where they where they where they can accept the documentation of another another colleague right in place or in on alongside a physician, but at the end of the day, my bill is based on my documentation. The hospital's bill is based on my documentation. Right. And so, yeah. That's that's a privilege. It's it's it's because the the physician's still at the at the center. But the physician is still at the at the is the is the leader of the team, right? And that's a that's a privilege. That's a privilege. And and you know, our APP colleagues have that same privilege, right? So it's not just physicians, it's also our APP colleagues and the APP clinicians, right? So the clin the the it it's it just goes with the territory. So when there are things like this, you update the family, that that they that I t say the exact same thing the nurse says, but it but it but it's well received when it comes from my mouth. rather than the nurse's mouth, then I just take it. Right. Again, when they have a query, it's it's it's yeah, yeah, it's extra work. and I'll admit it's annoying, right? You get a CDI query and you gotta go, you gotta log into the system and then you gotta clarify or you gotta write another note or you g yeah. my God. I'm not saying it's not annoying. It is annoying. And the billing And the revenue of the hospital is based on my documentation as a physician, mine, right? So that's that's at the end of the day, when you reflect on it, that's a privilege. It's a privilege. And you know, I keep harping on it, I keep saying it over and over again. th I I I I have a tremendous amount of gratitude being where I'm at, you know. one of these days I'm gonna, I'm gonna have. an episode about the rap song that makes me cry. And it has a something to do with this. you'll understand more when that when that episode drops sometime in the future. The rap song that makes me cry. But you know, it's just I'm I'm so grateful because this is this is my dream. This is my dream. And so I have to and that's why I that's last week's episode about one one team, one fight. is again I I I have to constantly remind myself right after step take step just like when I was in the marathon, October eleventh of this year, which if this, you know, hopefully which will be two days ago, you know, from this episode dropping. It was the Chicago Marathon. And in two thousand ten, ten, ten, ten, I ran the Chicago Marathon in my daughter's honor. And my cousin was running with me and he told me, man, step back and take it all in. Right? I'm running the marathon. So I think we have these these these these episodes are the way I step back and take it all in. That I'm that I'm living my dream. I'm not saying it sarcastically, that I'm living my dream. And so yeah, yeah. these things i it it's it's it's a it's a it's a it's not a burden, it's a privilege and it's a duty and it's an honor. And I have to remind myself of that every single day. Yes, uneasy lies the head that wears the crown and this job, at least for me, this career, is a dream come true and the honor of a lifetime. Thanks so much guys for your time and attention and I'll see you next time on Healthcare Musings. Thanks for listening. Healthcare Musings is a production of FaithfulWord Media. Sign up at drhasabala.com to get every episode delivered directly to your inbox. And please don't forget to give the show a five-star review. Thanks so much.