Wednesday, 20 October 2010

More medical behaviour I don't agree with!

Geez this blog has turned from being green and kiddy related stuff to work whinge!

I was doing the acute pain round yesterday and there was a man with a supraclavicular block/catheter for his hand - he had a reimplantation of a few fingertips which was a work related injury.

The patient actually wanted the fingers terminalised but the plastic surgeon decided to try to reimplant the fingers.  And why do you think that is?  Because the patient is workers comp - which means $$$.

So the patient was complaining about his numb arm and I had to tell him that we leave the infusion for about 3 days to help perfusion to those fingertips, and the patient was grouchy because he just wanted to go home.  He was also having leech therapy to keep the blood thin in those fingers as well.

I was talking to one of my registrars yesterday who told me that he received a call from the anaesthetic consultant on call in the afternoon saying that he was coming in for a reimplantation of fingers.  The registrar was surprised because it wasn't on the Emergency list, and so went to the Duty anaesthetist who also didn't know about the patient.  A few minutes later there was a call from the plastics registrar who booked the case.

So the consultant anaesthetist was in, and told the registrar to put an art line in but he didn't care who put it in... and then I suppose he would have sent off some gases as well so you could claim serial ABGs.  I asked if they put BIS on and of course they did, and it would be paid because it was a trauma (therefore high risk - though in reality totally NOT high risk because it's not really a trauma).

So is it ethical to put in extra things that you don't need because you will get extra (a lot!) money for it?  Like SERIOUSLY.  If this was just a non work related injury the patient would not have had all these extra interventions.  It annoys me that people put extra things into workers compensation because of the extra money, and it seems like a total rort to me.  Would I do those things?  I don't think I would put in an arterial line or do gases.

This is such a small whinge, people will wonder why I whinge about it when there is extra money.  But to me this is unethical behaviour.  For monetary gain.  There was a young 15 year old boy who died earlier in the year, who had his arm ripped off in some machinery accident - 2 specialists said terminalise the limb but the plastic surgeon decided to try to reimplant it.  The boy died because of a transfusion related lung injury, an idiosyncratic thing which would not have happened because he wouldn't have needed so much blood products if they had just terminalised his limb.

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