The Rehabilitation Facility Sham by Steve Mussey MD

ice floe

If you are seriously ill or injured, you will likely spend most of your recovery days in a “Rehabilitation Facility,” far from your original hospital and doctor team. It is a system which is inefficient and poorly designed. One hospital may feed ten facilities of varying competence, spread out over wide areas.

How did we get here?

Years ago, an elderly sick patient might spend many days or weeks in the hospital.

After major surgeries, even a couple of weeks were typical.

This made sense. A full hospital staff and physician team of all specialties could intervene at the first hint of trouble. Even late at night, CT scans and STAT labs could easily detect danger. A doctor could rush to assess you on a moment’s notice.

Fevers, wound problems, shortness of breath, chest pain or other problems could be quickly managed.

Then, something changed.

We convinced ourselves hospital stays were too expensive and actually led to more complications.

Soon, hospital stays became very short, extremely busy, and even more ridiculously expensive.

To put it simply, a hospital day turned into an action-packed, whiz-bang adventure of pricey imaging, procedures, and surgical interventions.

Now, after one or two days of a typical stay, every super-cool thing has been done. There is nothing else to do.

“We’ve run out of expensive things. Time for you to leave….. NOW!”

But, where do you go? You can barely eat or walk. You still need several weeks of IV antibiotics. You also have a couple of tubes still draining fluids.

Enter: The Rehabilitation Facility! What a wondrous development!

Remember that old depressing under-staffed nursing home down the street? Well… The owners spruced it up a bit, added a little physical therapy, found a desperate doctor-designated nurse practitioner to be a medical director and… POOF!!!… Instant Rehabilitation Center!

Okay… It’s still under-staffed and depressing, but now it’s a REHAB Facility!

They’re everywhere!

What better place to recover, far from the skilled team of specialists who managed your complex conditions and did your intricate surgery? Here you can avoid pesky imaging, laboratory and doctor evaluation.

When you become a bit unstable late in the evening, you can do so in uninterrupted peace and quiet.

Don’t worry! All bleeding stops! You’ll be fine.

Sure, none of the specialists come to the Rehab Hospital. Your surgeon would never set foot in the place. No Cardiologist or other specialist has ever seen the inside of the facility.

In fact, your entire original doctor team has no idea where you are.

The facility doctor….uh… I mean facility Nurse Practitioner can visit you in the next couple of days.

Just try to hang on!

If it gets really, really bad and you stop breathing, they’ll send you to the Emergency Room in that distant hospital which sent you here.

So stop panicking!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “The Rehabilitation Facility Sham by Steve Mussey MD

  1. Bruce
    May 28, 2015 at 8:26 pm

    There are TWO kinds of rehabs.
    The one you are talking about are the PSEUDO Rehabs —they are in Nursing homes and you get rehab therapy once a day
    The REAL REHAB hospitals are exactly that–hospitals.
    1. they give rehab therapy three times a day in most, 2. Specialists DO go there 3. They have physiatrists (rehab MDs) . 4. They don’t keep you for ever….if you don’t get better, you THEN go to the NHs

  2. Elliot Wortzel
    May 27, 2015 at 4:15 pm

    It’s not as bad as you make it out to be. They WILL call your listed primary care doc at 3 AM if there is a problem! He/she might not remember who you are, know that you were in the hospital, what you were in for, what was done, or what meds you should be taking any more than the attendant who’s calling. But that was before EMRs! Now the doc can flip on a computer and get all the information needed to diagnose and fix the problem quickly, accurately, and comprehensively in a matter of a few minutes. Yet another problem that can be easily solved with a phone call and a computer! And if you don’t do well, the call also gives your lawyer another defendant in a suit. So there’s plenty to be optimistic about.

  3. Stuart Bergman MD
    May 27, 2015 at 1:29 pm

    I was in one for a month following subarachnoid hemorrhage. An ice floe would have been more humaine. The occasional polar bear would have given me superior care and been better company.

  4. Pat
    May 27, 2015 at 1:26 pm

    Another example of the obvious unsustainability of Medicare. All of the politicians and doctors who continue making “protect and strengthen” promises about the program are simply liars.

  5. Perry
    May 27, 2015 at 8:56 am

    Forget the ice floe. A bullet to the brain would be quicker.

    • hugo
      May 27, 2015 at 7:44 pm

      Ah, but they shut down all the lead processing factories in the U.S., so it’s no longer easy to find a bullet.

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