A nephrologist walks into a patient’s room in ICU . Patient is admitted with a potassium of 7.5. Potassium has a very narrow range 3.5 to 5.4 . Above 6.2 it can potentially stop the heart in diastole , basically mid beat.
Kidneys excrete potassium and if kidneys don’t work and potassium go high people call nephrologist (kidney doctor )to fix the situation.
The nephrologist had already prior to seeing the patient instructed the ER Doctor and Hospitalist about some emergency measures and the potassium subsequently had come down to 6.6.
Now in the room, after the nephrologist introduced himself and the reason why he was there the patient asked.
“Who called you”
“Your main Doctor . The Hospitalist and the ER Doctor ”
“He did not ask me”
“Well, perhaps because the situation was emergent he decided to get things going before he comes and talk to you”
“I don’t want people to keep hopping on my insurance train. Just because I have insurance you are here ”
Most Doctor will agree ,more then half of the patients we see in hospital on an emergency basis are uninsured or underinsured . In Most of these cases we don’t see any money.
Depending on how critical your field is , more pro bono you are going to work . Like ,a cardiologist ,trauma surgeon and an ER doc probably will do more pro bono work then an orthopedic surgeon or a cPulmonary/critical care Doctor and an orthopedic surgeon possibly more then a nephrologist and obviously a plastic surgeon who specializes in boob jobs will Likely never be called for an emergency. Except of course if a porn stars implant burst open during athletic sex.
In this case , as usual the nephrologist had not looked at the patient’s face sheet before rushing to ICU . Like always doctors don’t look at insurance Cards before responding to emergencies. I m not saying we don’t care about money , of course we have families and dreams too but when somebody calls , we go.
Potassium greater then seven puts an automatic spring in your feet.
“Well your potassium is high . It’s better then before but it a still high. It can potentially kill you”
“It’s won’t. It’s getting better and it will get better when we check the next time ”
“Do you not want to see a kidney Doctor ”
“I don’t ” the patient replied resolutely.
And the nephrologist had to leave the room.
True story .