Sunday, March 29, 2009
In my line of work, it is important to get along with one's coworkers. Doing shift-work means that we don't stay until the patient is dispositioned. Often a patient gets seen and examined, labs and imaging studies are ordered, and then their care is transferred over to the new doctor when it is time for the original provider to go home. In regards to patient care, this can be the most dangerous time for the patient as the incoming doc typically doesn't have time to fully re-evaluate the patient.
As you can imagine, everyone has their own level of comfort in decision making. After you get to know the other doctors in the group, you can typically figure out who is going to have more patients to sign-out because they tend to order more tests than everyone else, who is going to do very minimal work-ups, and who is going to intentionally order a CT scan fifteen minutes before the end of their shift so that they don't have to make the decision about what to do about the patient during their time in the department.
Like every other job, it's frustrating to get additional work handed over to you by people who seem to be determined to get by doing the bare minimum. It also stinks to come in to a full waiting room and patients who have been in rooms for hours, not seen by anyone, and the previous staff heads home seemingly carefree on-time.
At my place, we've come to refer to bad sign-outs as steamers, because the messes left behind are reminiscent of steaming piles of... well, you get it. Sometimes it's unintentional, but sometimes someone who's billed as "stable" suddenly deteriorates after shift change and it seems to be more a factor of a shoddy exam or workup because someone was in too much of a hurry. Extreme examples of this would be the patient signed out as "possible pneumonia" ending up needing a pelvic exam because their "rib pain" turns out to actually be belly pain, or in one really bad example, a "stable" patient coding in the CT scanner.
After being in a hospital for a while, you get to know how your night's going to start depending on who the previous shift was, and steamers definitely happen at both the attending and the resident level. I think that all of us ultimately want to do right by our patients and co-workers, but when there are so many interruptions in care throughout the shift, it becomes easily to get distracted, especially by the thought of it being past time to go home. It does get old after a while, and I can't imagine what it's like to be in the same place, taking bad sign-outs from the same co-workers over and over, year after year. While the names and faces will be changing out in a few months when I leave, I am sure the situation will be the same.