One of the things the doctor kept repeatedly saying to his patients was that they had to "let things go, and not let people rent space in your head for free." A lot of our patients would hang on to one sliver of time for years, and never be able to let one altercation or instant in time go.
Late last night, I was guilty of letting someone rent space in my head. I saw a teenager who kept having episodes of fainting and dizzyness over the past year. He kept describing a barrage of symptoms that didn't really seem to all fit together. After making sure that his heart and electrolytes were fine, I had to call in a consultant.
The resident finally came to see the patient two hours later. This patient had arrived in our department at about 7 pm and it was now midnight. Granted, while I was seeing other patients, the resident spent at least a half-hour talking to the patient. Later, I saw him on the phone, and then he left. When I walked by my patient's room, I noticed that he was in his street clothes. He told me that the neurologist had said that he could go home.
I checked his chart: there was nothing written down.
I talked to his nurse: she said that she hadn't been told anything about the plan for the patient.
It was now almost 1 am: I had the resident paged. I asked him what his recommendation was, and he said that his attending just wanted to send the patient home and have him follow-up with his regular doctor. I asked him if he'd written a note in the patient's chart. He said no, that he had dictated his note. I said I needed some sort of documentation in the chart that he had seen the patient and what the recommendation was, as his dictation would not be transcribed or visible in the computer for several days.
He told me it has never been an issue before, and then demanded to talk to my attending.
I told my attending what had happened, and he just kind of said, "This has been a problem with consultants since I got here in 1993." I asked him to back me up, and explain to the resident that if he doesn't write a note in the chart, or at least speak with me about the patient, I have no way of knowing what the recommendation is. Fortunately, my attending backed me up.
I ended up staying until after 3:30 am (my shift ended at 2:00) catching up on my own dictations and preparing a case for conference on Wednesday. About 3 am, I saw the resident slink into the department and write a note. He didn't bother to talk to me, which is fine. I was still pissed off when I got home, and am still a little annoyed today.
I can handle being criticized by other departments when they don't like our workups or don't think that they are being appropriately consulted. However, when they do finally get their special-selves in to see the patient, I expect them to conduct themselves professionally. Most of them do write notes, and this is pretty much a resident-run hospital.
Somewhere, there is an attending physician that gets to bill for his opinion on this case that he discussed with his resident. If his opinion is important enough for him to bill for, or that I have sought it out, it needs to be documented. For them to not bother to even speak to us is not only rude, but potentially harmful to the patient. It is completely unprofessional and potentially dangerous for him to expect the patient to tell me what's going on. Even though I'm calling him for an opinion, unless that patient gets admitted, he/she is still in my care as long as they're in the department.
Hopefully, as I think this is a pediatric resident, I won't have to work with him all that often. However, I do want to find out more about what the official policy is on consults. One shouldn't be able to get payment for an opinion that you don't share with your colleague, and I certainly wouldn't have put up with this crap since 1993! I suppose it is a little unorthodox for an intern one-month into her residency to be calling out a senior resident, but seriously: do your job right, and I won't have to tell you how to do it. After four years of college, four more of medical school and whatever number of years in residency, one should have communication skills slightly better than your average chimpanzee.
On a happier note, yesterday I picked these up at the grocery store:
My ex-boyfriend was a huge Seinfeld fan, and he got me hooked on them. Some time ago, they stopped selling them in Arizona, so I was happy to see them here yesterday.
Also, I put seed into the bird feeder left behind by the sellers. It was then that I noticed the company name: Droll Yankees. Something about that just makes me happy.
For some reason, when I look at my blog, I can't see my last two entries. Is anyone else having this problem?