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Trauma, continuing care

Ronald Gross Rgross at harthosp.org
Fri Oct 21 11:58:42 BST 2005

"Fortunately this Marcus Welby paternalisstic model of care is almost dead."

All I can say is "Fortunately I work with physicians who  have more dedication to their patients than does Horan.  "  On the other hand, if he ever gets admitted to my service, I will make sure that he sees a new, bright, energetic and awake resident every eight hours - one who has seen the transfer of infomation denegrated by 30% with every signout.

>>> thoran at sarah.br 10/20/2005 3:11:20 PM >>>
Dear Sheila,

What motivates your question?

It does not have an easy general answer. The definition is probably better left to the individual practitioner or service or hospital to decide since it has more to do with the practical capabilities, interest, and admin structure within each environment. 

What the Libby Zion case of over 20 years ago has to do with a definition of acute trauma versus post acute on going care is beyond understanding. As you undoubtedly already know, the Zion case was about demerol administered to a patient on MAO inhibitors by a resident on his 23rd hour of continuous service. The patient  died of respiratory failure. Apart from the proven malpractise, Libby Zion's father a lawyer and part time editorialist / commentator for the NY Times managed to get a grand jury investigation into working hours of residents. The judgement that came from this  is responsable for moderating resident work loads to 80 hours / week. Two decades later the results of this case still grate on the sensibilities of the John Wayne types in surgery. You remember "aaah maanz gotda do   whadah maanz gotda do". 

The individual responsibilities were decided at the lawsuit. The hidden structural causes were in part addressed by the grand jury. The wide base upon which such adverse outcomes are "achieved" are much greater in importance than the sharp point of one case and its media hype. Basing your arguments on the details such controversial cases such as the Zion case  does little to illuminate structural problems within the system. The argument continues today and in large part underpins much of K´s medical political commentary.

 The topics of continuity of care, medical malpractise, methods of payment, hours of service, and service structures are one thing. The definition of acute or emergency trauma versus chronic care is another. In Ken's world the doc you get in the ER is the one who stays with with you until HE decides to quit. Fortunately this Marcus Welby paternalisstic model of care is almost dead.

Good luck in getting your answer, you might try a list dedicated to medical administation.

Yours truly

Tom Horan

> ----------
> From: 	KMATTOX at aol.com[SMTP:KMATTOX at aol.com] 
> Reply To: 	Trauma & Critical Care mailing list
> Sent: 	quarta-feira, 19 de outubro de 2005 23:20
> To: 	trauma-list at trauma.org 
> Subject: 	Re: Trauma, continuing care
> Sheila:   I am still of the opinion that a surgeon and a service  that 
> accepts a patient and admits that patient to the ICU, hospital bed or  operates upon 
> them has TOTAL responsibility for that patient during that  hospitalization, 
> until another physician, (NOT A TEAM) accepts the  responsibility for that 
> patients health problems.   The surgeon might  get someone to consult on problems 
> that the surgeon believes are beyond her/his  capability, but the admitting 
> doctor did take on the responsibility when the  patient was admitted.   We do 
> not practice medicine by a clock  punching team.   The patient wants one 
> doctor.   You did not  ask about an obstetrician who might start a delivery, only to 
> hand off to  another in the middle of a delivery because her/his shift is up 
> and therefore  their responsibility is over.      
> Continuity is in order.   The Libby Zion case was all about loss  of 
> continuity of care, not fatigue.       
> k
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