Things have been rather busy at Pal’s place. For whatever reason, the complexity of patients has been pretty high lately, so I haven’t had a chance to get in my usual once or twice a day post.
I’m told that “back in the day” internal medicine patients were a bit less complicated. These days, to get admitted to the hospital, you have to be pretty damned sick. The hospital has to be able to justify your admission based on “severity of illness” and “intensity of service”. In simple terms, you have to be sick enough to need care that cannot be provided elsewhere. The days of being admitted for “rest” or for “a workup” are gone.
It’s not uncommon for a typical hospitalized patient to have several illnesses, and for the treatment of one to be incompatible with the treatment of another. Many, many patients are treated with various sorts of medications to prevent blood clotting. People with a common heart rhythm problem called atrial fibrillation are usually on a potent anticoagulant called warfarin. Patients with drug-eluting stents in their coronary arteries are often treated with an anti-platelet drug called clopidogrel. If a patient on these drugs develop gastrointestinal bleeding—a common enough problem even without blood thinners—treating them becomes a real dilemma. Stopping the blood thinners may lead to devastating clots, but failing to may lead to life-threatening bleeding.
Patients with atrial fibrillation may have a risk of stroke as high as 8-10% per year, a risk that can be cut in half with warfarin. The risk of severe gastrointestinal bleeding is lower than that (depending on a number of factors), but it still happens. Given this, we’re going to see a lot of people with atrial fib in the hospital, either for GI bleeding or for stroke (not to mention for control of the arrhythmia itself).
All this is my way of saying medicine is never boring. But it’s sometimes busy.
In addition to hospital rounds, I’m going to a birthday party for a five year old buddy of my kid. Other than that, who knows?
So, what are you up to this weekend?