Samuel Shem's iconic House of God describes the block with hyperbole. When the emergency department calls for an admission, you try to block the patient and turf him to a different service. If you're an orthopedic surgeon and the patient has a hip fracture, maybe she also has chest pain so she would be safer on a medicine service with an orthopedic consultation. If you're an intensive care physician and the patient is dying of septic shock, perhaps you can dig up an advance directive and POLST saying the patient wouldn't want aggressive medical treatment in this situation.
This is not healthy behavior, but House of God describes why it proliferates; every service is trying to block patients, and if a physician accepts patients indiscriminately, her service will blow up in size. When we are residents and fellows, our clinical volume has no relationship to our salary so there's little incentive to take a lot of patients. Most specialty consultants master the art of the block, and as a result, patients get dumped onto the general medicine or intensive care services. We are the catch-all for any medical problem, so if no one else will admit them to the hospital, medicine will (or the medical intensive care unit if they are sick enough). In general, I was okay with that because the patients got better care, but the idea of blocking always bothered me.
Private practice is the exact opposite. For many of us (but not myself), clinical volume determines our revenue. I was surprised to learn consultants were eager to take on extra work and that there was no push-back when I asked other services to accept patients. A patient's disposition (the medical term of who takes care of them and where in the hospital they go) is determined entirely by medical factors. This is the way the system should be; physicians shouldn't block patients; we should care for them, treat them. Perhaps its not wrong to link this to financial incentives. The goal is to have a collegial and smooth-running system that focuses on the needs of the patient.
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In ancient Greece, the asclepion was a healing temple dedicated to Asclepius, the God of Medicine. Asclepius learned the art of surgery from the centaur Chiron and had the ability to raise the dead. The Rod of Asclepius is a roughhewn branch entwined with a single serpent.
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Hi! I am Craig Chen, a third year resident physician in anesthesiology at Stanford Hospitals and Clinics. I went to medical school at the University of California, San Francisco. Prior to medical school, I studied philosophy and biology at Stanford University, along with a minor in creative writing.
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