Tuesday, February 13, 2007

I'm Rubber, You're Glue...

I sat there this morning and kept my mouth shut. Around me there was smirking. I took a long swig of my coffee. It was too hot, and the liquid burned as it went down my throat, through my esophagus, and right into my stomach. Tonight my tongue still has the angry, sensitive sensation from the scalding. However, sipping at my coffee was the only way I could keep quiet.

I hate morning report. Morning report involves sitting around a large conference table and discussing a case that was admitted overnight. Typically much bashing of the Emergency Department ensues. Today's case was a four-day old infant with bloody vomit who also had a fever. A full septic workup was started looking for a source of the fever by checking the blood, urine, and CSF. The baby was started on antibiotics and admitted to the floor.

The head pediatrician started in on how the cause for blood streaks in the vomit wasn't worked up very thoroughly, and how he thought that the antibiotics weren't really necessary as the infant was being monitored in the hospital. Then he made some snide comment about the ER starting antibiotics as we just wanted to avoid lawsuits in the event of a bad outcome.

Does he consider the unnecessary death of an infant a "bad outcome"? Why is it ok to take chances with someone's child? Our job in the emergency department is to look for life-threatening conditions. Yes, most of the time we see people who don't have a doctor or can't get an appointment. However, in the event that we do find or suspect something serious, we act on it. Otherwise, it would be called the Let's-Just-Order-A-Shitload-Of-Tests-And-See-What-Your-Dumbass-
Doctor-Wants-To-Do-In-The-Morning Department.

Granted, there could have been a little bit more of a workup done for the vomiting. However, the kid was already being admitted to the hospital, and the mother gave a history that her nipples were chapped and sore from breastfeeding. The blood could have been swallowed or it could have been coming from the baby. There's a test that can distinguish maternal blood from the baby's blood that could have helped with this, but it takes awhile to get those results. Is it asking too much for their department to do something more than just sitting back, observing the patient, and waiting for our results to come back? Does it pain them to have to do some work?

This is a problem that I will continue to face. When patients are passed between departments, either side often has issues with the other. However, I think it's rude for them to be so critical when they know that I'm sitting right there. It also didn't help to improve my mood when it turned out that many of their residents were clueless as to when to start the workup, or how to even do it.

Sometimes it's hard to keep a poker face when you really just want to tear someone apart.

1 comment:

ru said...

So doctors play the blame game too, eh?
I finished the diary last night and was exhausted. Internship is no fun and seems an exhausting way of learning the ropes; You're almost there. Just a few more months and the grueling first year is over. I'm praying for you:)

I hope that morning report goes better.