ASK THE DOCTOR: With Dr. Keith Sadel, MD The State of Medicine: A Play by Play Synopsis
ASK THE DOCTOR: With Dr. Keith Sadel, MD
The State of Medicine: A Play by Play Synopsis
I’ve practiced as an internist for the past 23 years treating at least 3,000 patients annually.
Recently, I converted my practice to membership medicine (concierge) which allows me to spend extra time with patients. Through Preservation health, patients receive many benefits
including labs, IV fluids, and suturing. All this averts crisis and additional healthcare expenses. In the situation below, I depended on a flawed healthcare system.
An elderly male, let’s call him Ray, with cognitive deficits, came in on an emergency visit. He had intense fatigue and low blood pressure. His wife accompanied him and provided supplemental information.
Having a good historian is an asset. Abdominal pain was new. On exam the abdomen was tender, and Ray had normal bowel sounds. However, I was concerned about the possibility of an intermittent obstruction. Ray received IV fluid. I consulted with his cardiologist, adjusting his blood pressure medication. Ray received a script for an abdominal X-ray. We discussed a visit to the hospital, should symptoms worsen. His wife mentioned bad experiences in the past due to excessive wait times and did not want to go to the ER.
The next day the pain worsened. I was able to get Ray a stat abdominal CT scan. Radiology called me as Ray was vomiting. I wish that I could do surgery right in my office. An acute obstruction was detected. Given that radiology was in the hospital, I thought that Ray could be easily transferred to a surgery consult or the ER. This was not the case.
The ER asked Ray’s wife to take Ray to another hospital, which is not standard of care. I spoke with the radiology technician to try to get Ray moved, but we were getting nowhere. Multiple people told me there was nowhere for Ray to go. Patients are triaged given their severity. An acute obstruction is a surgical emergency. After a few long hours of delay, Ray finally was sent to surgery.
In reviewing the situation, I have multiple conclusions. With Preservation, there were no delays on my end. I helped Ray in our office and then in navigating the system. When Ray had to leave my office that is when he encountered many obstacles.
The emergency room was overcrowded with situations that might not be true emergencies. That causes triage to fall apart. These are the bottlenecks, and they are seen repeatedly in emergency rooms throughout the country. Nursing and doctor shortages remain a frequent and serious problem.
Medicine is on life support. Doctors like myself are trying to save it. Your questions and opinions are welcomed in proposing solutions.
Dr. Keith Sadel is a board-certified Internist with over 23 years of experience. His focus is on preventative medicine and, more recently, has focused on personalized membership medicine. His goal is to merge modern medicine with age-old holistic practices. In addition to Preservation Health, Keith and his wife own and operate Lma Mineral Float, a holistic clinic on the first floor of his medical office. Lma offers float therapy in magnesium-rich water, sauna, and CBD remedies, all ailments to reduce stress, pain, and inflammation and to increase relaxation.
As Seen in The Doylestown Cardinal