I do these in-hospital rotations two to three times per year. I usually get pretty anxious beforehand, since the vastly different “rounding” schedule throws my normal patterns into disarray. Also, the patients are much sicker. These folks are in the hospital, after all.
I always wind up enjoying my hospital rotations. Mostly because helping very sick people get better is emotionally satisfying. Also, I find that working with the residents, interns, and students is rejuvenating and keeps me on my toes intellectually. I learn a lot. Invariably, I see and experience things that I’ve never seen before.
The hospital is incredibly dynamic. So much goes on in such a short time for a hospitalized patient that it’s enough to make anyone’s head spin. That includes us doctor-types, who in theory are calling the shots.
That’s why when there’s a relative standstill, it’s very noticeable.
My dictionary defines inertia as “Resistance to action, motion, or change.”
Some of the patients that get admitted to our service typify this. No matter how many adjustments we make in their management (medications, which specialists we consult, what IV fluid we provide), they just seem to stay in bed. That’s why I encourage my team to order that patients get out of bed, at a minimum to sit in a chair every day. I call this type of inertia bedrest. Bedrest is a time-honored therapy that has been shown in condition after condition to be counterproductive. I hate bedrest inertia.
Sometimes patients get better, at least to a plateau point where they no longer need ‘acute care’ hospitalization. They may not be well enough to go home or resume their normal activities, thus requiring a short stay in a rehabilitation hospital or at a skilled nursing facility (i.e. nursing home).
For many reasons, but usually having to do with their insurance benefits, these patients may stay longer in our hospital than is medically necessary or justifiable. The hospital doesn’t like this since the insurer will decline payment for the ‘extra’ hospital days. Also, a well patient occupies a bed that might go to a sicker patient in greater need. This is discharge inertia.
Patients that I care for in my office have their own type of inertia. I call it denial or ‘pre-contemplativeness’ inertia. This occurs when a patient is overweight, or has high cholesterol, and pledges to make appropriate dietary and exercise interventions to counter these risk factors.
Maybe I’m too soft: At visit after visit, some of these patients continue to tell me what they think I want to hear (and genuinely do!)–that they’re going to make the changes necessary to improve their health. But they don’t do it. I think almost everyone can relate to that.
The same type of inertia holds true for medications. I can prescribe what I know to be safe and effective therapy; even though some patients insist they’re taking their medications, I know they don’t take their pills. Should I yell? Some doctors do–and they have their adherents, people whose lives they’ve changed (e.g. by getting them to quit smoking or stop eating junk food), but yelling usually winds up alienating more than it helps.
Let’s not forget that doctors are complicit, too. We engage in therapeutic inertia. This type of inertia occurs with patients on medication, e.g. blood pressure medication. At their office visit the blood pressure is improved but not yet optimal. Often we chicken out of making a necessary adjustment. Maybe because it’s easier not to rock the boat. Maybe the patient has indicated they are happy with their regimen and do not wish to change.
If I had to summarize, I’d say that in health, inertia is a positive: If you’re in homeostasis–biologic balance–and feeling good, resisting change is probably the way to go. But in health care, my examples above show that inertia is a counterproductive force when one is ill and trying to return to a state of health.