A Patient in my own hospital by Paul Levy

Paul Levy is CEO at Beth-Israel Deaconess Medical Center in Boston. Paul was one of the  first CEOs to embrace blogging and continues to use his popular online column as a forum to express his views on the business of healthcare, public policy in Massachusetts and the challenges of being a manager in a very challenging field.  In this latest post he addresses a problem you wouldn't think would be problem for a top manager at a facility affiliated with Harvard Medical School:  The very real risk to his health his job poses. He blogs at Running a Hospital. 

Two stories about being a patient in my own hospital.

(1) I am really lucky to have a primary care doctor who knows how to protect me, as president of our hospital, from our well meaning doctors. Why do I need protection? Well, because the specialists are really proud of their work and want to use any malady that I have to show me their stuff. My doctor knows how dangerous this can be!

A few years ago, I signed up for an ocean kayaking trip in Patagonia. This was to entail pretty strenuous outdoor living and paddling all day long for two weeks. The program therefore required a physical exam and recommended a stress test for those over a "certain age." So I asked my PCP to order one.

She says, "No.  I refuse to order a stress test for you."

"Huh?", I reply intelligently.

"Here's the deal," she says. "If I order the stress test, our especially attentive (knowing who you are) cardiologist will note some odd peculiarity about your heartbeat. He will then feel the need, because you are president of the hospital, to do a diagnostic catheterization. Then, there will be some kind of complication during the catheterization, and you will end up being harmed by the experience."

"But the reality is that whatever peculiarity he might find in your heartbeat has probably existed for decades, or your whole life. There is no history of heart disease in your family. You ride 100 miles per week on your bike and play and referee soccer for hours every week, and you have never had a symptom that would indicate a circulatory problem. Therefore, I will not authorize a stress test."

"Yes'm," I dutifully reply.

(2) A few years ago, I had a routine colonoscopy, and the GI doctor clipped off a couple of polyps and sent them to the lab for analysis. Standard practice to see if they are pre-cancerous.

Three days later, I am walking to work next to one of our pathologists down a very busy Longwood Avenue. I say, "Good morning. How are you?"

He quietly replies, "Fine, and so are you.  I did your histology yesterday.  No problems.  Have a pleasant day."