Feature Christmas 2009: Professional Matters

Selling patients

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5201 (Published 14 December 2009) Cite this as: BMJ 2009;339:b5201
  1. Peter Nugus, research fellow1,
  2. Jackie Bridges, senior research fellow2,
  3. Jeffrey Braithwaite, professor and director1
  1. 1Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
  2. 2School of Community and Health Sciences, City University London, London EC1V 0HB
  1. Correspondence to: P Nugus p.nugus{at}unsw.edu.au

    The way hospital departments “sell” patients to each other has been parodied but seldom studied. Peter Nugus, Jackie Bridges, and Jeffrey Braithwaite explore the rules of the game

    “Since…gomers [Get Out of My Emergency Room] don’t die…the tern [intern] had to find other ways to turf them…The problem with the turf was that the patient might bounce, i.e. get turfed back…The secret of the professional turf that did not bounce, said the Fatman [a supervising Resident], was the buff…‘Because you gotta always remember: you’re not the only one trying to turf. Every tern and resident in the House of God is lying awake at night thinking how to buff and turf these gomers somewhere else.”

    “‘[That doctor’s] so scared of missing something by sending the patient back home that he admits them all. He’s a sieve…he lets everyone through…Be a wall. Don’t let anyone in.’…A mind-boggling thought: the delivery of medical care consisted of buffing and turfing the seeker of care to somewhere else. The revolving door with that eternally revolving door always waiting in the end.”1

    Introduction

    Everyone’s got something to sell. Retailers sell products. Workers sell their labour and skills. Everyone sells their status and knowledge; academics and clinicians are prone to this.

    Emergency clinicians sell patients. Why? Emergency departments the world over are under pressure to diagnose and treat patients efficiently, and move them on as quickly as possible.2 There are always new patients arriving in the queue. Who’s the buyer? The rest of the hospital. In the UK, in particular, GPs package patients for the hospital, too.

    The novel House of God by Samuel Shem1 satirises the games and strategies that characterise the transfer of patients. With similar irony, Innes3 wrote about “Successful hospitalisation of patients with no discernible pathology.” Innes prescribed 11 …

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