When you're a resident, you discover the myriad ways that one person can screw another. And you might imagine that having a bad intern would be the worst possible fate, or maybe as an intern having a bad senior resident would be tops. Now, having a bad intern can generate a lot of extra work, but there is no screwjob worse than what one senior resident can do to another.
This extends to both same service or consults or transfers of care, or best yet the ER. In all circumstances, the worst that can happen is always the same: one senior resident screws another one over.
I've been called to the ER to admit patients who don't even have charts yet, or labs, or even an x-ray. I've been called to admit a patient for observation for chest pain without an EKG having been done. I've had fellow medicine residents hang onto pending admissions until I took over the admission pager, leaving me with the new admission.
And worst of all, I've had residents lie to me about a patient's condition. That's by far the most common and most horrifying reality of the incompetence of some senior residents. For your benefit, some examples.
"Oh, her blood pressure was low, but it responded well to fluids. She's stable now." The patient was in florid neutropenic sepsis, and expired about 6 hours after this statement.
"His last cardiac cath, they didn't need to do any stenting, so he looks pretty okay." They didn't stent because he had triple vessel AND left main disease. He was a cardiac cripple.
"His last admission BP was low as well, so it looks like this is normal for him." So normal in fact that the last admission they addressed that blood pressure with dopamine and levophed.
But by far, the thing that gets me angry the most isn't this gross malpractice that I've described, but it's laziness. That's what bugs me. I've had people dump tons of work on me, couched in the noblest of excuses: "My son has to go to the doctor's today" "I have a meeting I have to go to"
Boo fucking hoo. More than once, I've had someone dump work on me so that they could leave the hospital for something, and as a result, I had to spend extra time in the hospital cleaning up their mess. And some people would flatly refuse. But I say bring it on, because if I meet someone who is so lazy that they are willing to dump their work on me, then I'd rather do it then let them ever take care of one of my patients ever again. I have literally carted people out of the ER and straight up to the ICU without a thorough evaluation because the care they had received was so atrocious that even blind, I could do a better job.
My feeling is that one person's laziness doesn't excuse me from providing poor care, so I will always pick up the slack. And it's a small price to pay to find out what doctors aren't worthy of my trust or my time.
It's always a case of damned if you, damned if you don't. On one hand, if you take the admission or transfer, you've just saddled yourself with at least 1-2 hours of extra work, which is not something your intern will forget, especially if you've been getting slammed all day, and your service is due to stop admitting in 5 minutes. On the other hand, if you stand your ground and demand that the doc calling the patient out to you should actually do their job, there is a finite probability that they will in fact cause grave harm or death.
ReplyDeleteUnfortunately (for my interns), my stance is to bite the bullet and take one for the team. For some strange reason, I feel less guilty when someone dies under my watch than if someone dies under someone else's watch because I refused to take the turf. This has no doubt resulted in my interns cursing my name, but what are you gonna do?
If they're good interns, they'll just suck it up and do the work. I don't understand being lazy when we've only been doing this for seven weeks. Every experience, even a nonsense consult, is a learning experience. How would you recognize bullshit if you've never seen it, spent some time thinking about it, and made yourself worry that it may not, in fact, be bullshit? I'm on urology right now, and we get consulted for things like "difficult foley placement" and "'hematuria' that is really just dark yellow urine." So, I have learned when it is appropriate to sign off of something like that, and how to be politically correct when telling the primary team that they gave me a stupid consult. It's a lot of paperwork, but interns can even use some practice with that. I'm just happy if someone wants to teach me, and help me get over my terror of doing something wrong.
ReplyDeleteHey guys,
ReplyDeleteI didnt know where else to post this so I thought I would just comment and hope you or perhaps another resident sees this and can help me out. I'm not really too sure about what internal medicine is, I mean I understand things like Emergency Medicine would put you in the ER, Gen Surg would put you in the OR, Ped etc. but Internal Medicine? Where are these doctors located? Do they just sort of bounce and work up patients in all wards? Are they the guys in the ICU? Is Internal Medicine kind of like the general medical speciality?
Thanks a lot,
Grayson Wilson
Dude, do a websearch.
ReplyDelete