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Special Article
April 25, 2005

Business as Usual

Arch Intern Med. 2005;165(8):838-841. doi:10.1001/archinte.165.8.838

I read the case on the monitor screen: “47-year-old man with colon cancer, electively admitted for partial colectomy and diverting colostomy, no positive nodes. Five days approved. Discharged after sixth. On last day, ambulatory with assistance, full liquids, no IV meds. Sixth day necessary? Denial?” I telephoned the surgeon’s office. The secretary put me on hold.

“Dr Garrison’s office. May I help you?”

“This is Dr Burnham. I’m reviewing the recent admission of a Mr Martin, one of Dr Garrison’s patients.” I read the disclaimer script taped to all desks by our legal department to protect against lawsuits: “‘This is a recorded and monitored line for quality assurance purposes. Quality Solutions Limited [QSL] is a medical review company and therefore not responsible for either benefits or payments.’ I’m calling regarding the acute medical necessity of his sixth hospital day.”