Gentle Readers,

Mrs. Dr. J. was battling a GI bug for the better part of last week. By Thursday she was so rundown, and felt sufficiently weak that after discussing her symptoms with her PCP by phone, it was decided that she should present to the New Atlantis Ivory Tower Medical Center Emergency Department for volume resuscitation (aka a couple of bags of IV fluid).

Now President Obama would probably say she should have been offered a magic blue pill rather than over tax a level one trauma center’s emergency room over something as trivially easy as popping in an IV, hooking it up to sterile IV tubing and running in a couple of bags of normal saline. Shoot, she and Dr. J. have the skill set that they probably could have done this at home, right?

Even Dr. J.’s clinic nurse at an affiliate hospital asked, “Why don’t you just bring her in here? I could hook her up to an IV, that’s what we used to do in private practice!”

Indeed, even about 12 years ago, one of Dr. J.’s colleagues was horribly dehydrated when she had pyelonephritis during her pregnancy. Mrs. Dr. J. got a call and was able to grab a couple of bags normal saline, an IV, some tape and tubing and run over to our friend’s house.

All you had to do was punch in a code to unlock the supply cabinet, grab the stuff and go.

That would NEVER happen today. You can’t get into the hospital or infusion-area supply cabinet without linking the supplies taken (IV tubing and bags of saline) to a specific patient . Therefore taking them would be tantamount to fraud. The internal medicine clinic doesn’t do procedures more complex than lancing a boil, so administering IV saline, even if the supplies were nearby would not be done because it’s beyond the clinic’s scope of practice.

There are still private practice doc’s who could have performed this service off the books, but he couldn’t accept remuneration as he would be jeopardizing his ability to bill Medicare/Medicaid.

So Dr. J. wants to thank the ER for their stellar care of Mrs. Dr. J., but he still couldn’t get over having to go to the ER for something as trivial a couple of bags of IV fluid and a shot of IV Zofran for the nausea.

Dr. J.