So I'm talking to my brother one day. He's a cardiologist. He tells me about a patient he once saw that was admitted to the cardiac specialty hospital with massive ascites, abdominal discomfort and a diagnosis of acute heart failure (thus the heart hospital admission). He called me up and asked me how to do a paracentesis. I asked him why he was even thinking about doing it. He said he was told the GI guys don't do them. That the GI guys will usually recommend a general surgery consult to do the paracentesis ( I can only ponder why).
I laughed. That's hilarious. A general surgeon for a paracentesis? I asked why the interventional radiologist just doesn't do it. Politics he says. They almost never come over.
I'm not sure which part is funnier. A general surgeon doing a paracentesis at a heart hospital or a cardiologist doing a paracentesis at a heart hospital. It turns out the hospital doesn't even stock the paracentesis kits. To do one, he would have to jimmy rig a make shift MacGyver kit by combining certain aspects of the pericardial needle and thoracentesis apparati.
I told him to be careful about doing the paracentesis himself. Not because he might miss the 10 liters of fluid bursting through the pregnant man's belly. But rather that word might spread through the hills that a cardiologist is doing a paracentesis. I thought to myself he's either a genius or an idiot. Either he would be considered the greatest cardiologist that every lived, or he might start getting 3 am consults from the GI service to do their paracenteses for them.
This story is but a microcosm of what is wrong with our fee for service health care. A heart hospital that doesn't stock paracentesis kits. A specialty that doesn't want to do them, even though ascites is a big part of GI medical training. And a cardiologist, a hard working one at that, who's willing to do it himself because he's too embarassed to ask a general surgeon to do it for him. That's a true internist at heart.
And through all this, I forgot to ask. Where was the hospitalist? I would have been all over that, if I wasn't too busy doing a hospitalist preoperative evaluation on healthy 34 year old pig farmers. That's not the role of an internist.
