The Art of the Block with Abhi Kole, MD
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What legal safeguards are mentioned at the start of the episode?
At The Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer. This episode of The Nocturnous was made possible with the support of the California Medical Association and Vocera Communications Experience Innovation Network.
Sometimes the hospital gets busy. Way too busy. Let's say you have twelve patients and then you get paged about two more. And then another two, and then another two, and you're sleep deprived and overwhelmed and struggling to manage. What do you do? This is The Nocturnous, stories from the world of medicine. I'm Emily Silverman. Today we hear a story from Abby Cole about the ethics and the art of blocking patients.
I think that under times of stress, the ideals break down.
Afterward, Abi and I talk about how many patients is the right number for one doctor to take care of and what are the emotional barriers that come up when it's time to ask for help. Here's Abby.
Every doctor at some point in their lives has written or said the words because I want to help people. Whether it was in our personal statements or residency application, job interview, we've all said it. What I never anticipated was that one day I would have to qualify that statement. I want to help people, just not too many people. Like when I was evaluating a patient in the ER that was struggling to breathe, but at the same time another one of my patients is having a heart attack on the floor and I don't know which one to go to. One night I was admitting and I was called to see three patients in the span of two hours. I was uh pretty busy, but I had seen them all, and I was writing my notes furiously on the computer before I got called about the fourth one, when I see one of the residents a year ahead of me walk into the resident room and he's looking far too relaxed.
So I say, Hey Jason, are uh aren't you also three admissions in? How are you finished with all of your work so quickly? And he looks at me and says, No man, they none of those admissions were appropriate for medicine, so I told the ER we weren't gonna take them. Wait, what wa what black magic was this? You're telling me. That I don't have to admit everyone I'm called about. And that's when I learned about blocking. Blocking is when a patient is assigned to your care but you decline them. And Blocking can be done for a variety of well meaning reasons, like maybe the patient is too sick for your service and should actually go to a higher level of care. Or maybe their problem is surgical and I'm a medical doctor, I'm an internist, so they should really go to a surgeon and not me.
Or maybe they're not sick enough to be in the hospital a at all. For example, I was once asked to admit a patient with high blood pressure. It's not uncommon, but I looked through his chart and I didn't see anything, uh any red flags, so I didn't think he needed to be in the hospital per se. So I walk down to the ER, I find the attendings room, and I very shyly peek my head in. And say, hey, so I'm seeing Mr. So and so with the high blood pressure. I can see that it's uh it is pretty high, but I actually don't think he's at risk of having a stroke or a heart attack or anything bad like that. So I was just gonna start him on some medicine, send him home. What do you think of that? And much to my surprise, the R attending says, Okay.
So I'm thinking, wow, this was easy. Uh and and I just save this man a hospitalization, everybody wins. And blocking became a culture, so uh and people that were good at it were idolized. Um, like my friend Jason, for example, he was so good at blocking that we had printed out a picture of him. put the words the art of the block above his face and made it and photoshopped it to look like Donald Trump's art of the deal. And this this hung up on in the resident room as like an inspiration to the rest of us. But as I'm about to tell you, blocking doesn't always mean well.
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