The guest was feverish, and his abdomen felt tender
and rigid, a sign of peritonitis. He needed to go to an emergency room. I phoned
his travel insurance to let them know.
This particular agency was a slow payer, usually a
sign that it would be hard to deal with. Sure enough, after hearing the news,
the dispatcher informed me that the patient must first go to the Airport
Medical Center, an urgent care clinic. It’s not part of a hospital, and the
doctor on duty has the same training as I.
Getting a second opinion before sending a client to an
emergency room saves the agency money, but it wouldn’t in this case because my
patient needed to go. There was always a chance the AMC doctor would send him
home, so I phoned the clinic to make sure he thought twice.
No sensible doctor tells another doctor what to do, so
I chose my words carefully. I was sending a man with bad abdominal pain and
peritoneal signs, I explained. I felt he needed to go to an emergency room and
be admitted, but his insurance insisted on an urgent care clinic. He thanked me
for the information. “We don’t have too many facilities here,” he added. “But
we’ll do what we can.”
“Don’t do anything. Send him to the hospital,” would
have been tactless, so I didn’t say it.
Once a doctor decides a patient needs emergency care,
allowing a test to change his mind is a bad idea. For example, an abnormal
blood count points to an infection. Good. But what if the blood count comes back
normal? The answer: send him anyway. Doctors shouldn’t order a test that won’t
change the treatment, but we do it all the time.
So the man spent a few miserable hours while the
doctor ordered tests that doctors order when a patient has a fever and
bellyache: blood work and an abdominal x-ray. I have no idea of the results,
but I checked to make sure he’d gone to the hospital, and he had.
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