When the Vultures Circle

Not far from my house is a tree where vultures nest. One evening, my wife and two of our friends counted 42 vultures settling-in for the night. They came in about 90 minutes before sunset, gracefully floating on thermals, heading right into their favorite tree. A neighbor, originally from Brazil, told us that there vultures were held in high regard because of their ecologic role as scavengers.

When I was a hospital medical staff officer, I witnessed a different vulture experience, usually in the intensive care unit (ICU). It typically involved a circle of physicians with mediocre professional skills who took turns consulting on each others' patients. The same physicians gorged themselves on these patients' resources and extended patient stays through unnecessary and inappropriate consultations and tests. The ICU nurses, when asked, would explain that they did not even know which physician was primarily responsible for these patients' care. These nurses complained that when they called these doctors, each would claim only to be a consultant and not primarily responsible for the patients. Even the patients' families could not get a physician to acknowledge primary care responsibility.

While the vultures circling in my neighborhood provide a useful societal service, vultures circling in ICUs not only signify a poor prognosis, but questionable medical competence and ethics. A patient, and patient's family and friends, should demand accountability from each professional with whom there is any contact. . . and should check the bill to determine whether the two minute blow-through visit was billed as a high-priced full complex consultation.