As a new intern, when they start to ask why tf I would consult them for something so stupid I just respond with "my attending wanted it". Usually, the fellow/resident on the other side totally understands and drops a three sentence note essentially saying everything is fine this was dumb.
Yup when I was rotating through Endocrinology and rounding on a patient being co-managed with Nephrology. We found out that their consultant changed our prescribed oral hypoglycemic drugs without informing us.
No worries, your infectious disease fellow will sigh, then spend an hour digging through the patient's chart, write a short novella as a note including a multiple paragraph assessment explaining how the patient doesn't have an infection and end with a single line plan: Discontinue antibiotics. ID will sign off. Thank you for this consult.
As a nurse, when nonsense verbal orders given I find they reconsider when I hand them the chart and ask them to write it... was most effective when indeed was on paper but... amazing how many times they didn't have time to do it on the computer. Love that in nursing verbals are supposed to be limited, maybe attendings need same.
Hahaha this is spot on! So true! Eventually I would say, "this is what my attending wanted. If you have a question then you can ask him to explain because I wasn't given an explanation either." Nine times out of ten once questioned by another attending they would change their mind.
"Better do what the boss says" is so relatable 😭 Consultant says "let's do this scan/consult" = "YOU do this while I go to my office and drink coffee" 😂 LESSON: ALWAYS ASK WHY! As long as it's with the aim of helping the patient, I'll do whatever
Yup...I always ask what the clinical question is when the attending demands a consult I dont agree with... Gets worse when they answer with "well, he had polypectomy 15 years ago that proved to be cancerous...dont we need Oncology?" Me screaming on the inside "to tell us WHAT???"
Brilliant! Had a pateint with recurrent fevers and after multiple blood cultures came sterile, my senior made me consult ophthalmology for endophthalmitis, with zero eye symptoms, when I asked him why he said just to rule out. Ophthalmologist chewed me out afterwards... On the bright side 2 days later a different consultant joined the unit and started an antifungal which made the patients fevers disappear completely
When you reach that point at the end of your training....😂 ....And then you become the junior consultant and you behave even more defensively than your former boss!!!
This is seriously my life every single day as an inpatient coder. Discharge summary: Patient had sepsis, no infection identified, did not meet SIRS criteria. I cry into my coffee.....
Lol, I work in the UK so there is no coding, but every shift I get a handover for patients who are 'generally unwell', which I imagine must be pretty hard to code for. Obv we then look for reasons for that, but with older patients, it's not unheard of to be admitted as generally unwell, query infection, no source found, bloods unremarkable, spend a few days in with physio and observation and then go home. Like, if you had to explain to an insurance company why they came into hospital, or what treatment we gave them, it would be pretty difficult! But they did need to be in hospital I promise!
Then you have to deal with the nurse. My strategy is usually not to fight the orders, but to let the patient know that they have full autonomy to decline anything they don't agree with (when they legally can consent) and update them on the plan. Then you can just tell boss that they refused all the stupid orders & actually have to go talk to the patient
And now their insurance won’t pay for anything due to their noncompliance. So the patient is bankrupt and the hospital doesn’t get paid. Excellent plan. 🙄
SO TRUE - in EMS as well, having to call medical control to clear an RMA for someone having a panic attack because technically their respiratory rate is too high and then medical control insists on sending a paramedic unit to come assess her and now you're getting funny looks by the medics for getting them requested for a panic attack.
I'm not even in the medical field, but I've spent SO much time in hospitals over the last 20 years due to my husband's chronic health issues, & now, my own, that I really can feel for the characters in these skits. It's a wonder to me that I've never seen a young doctor just hurl themselves right out a hospital window to end the madness!!
Lol, that's why the windows in my hospital don't open at all. It's not for patient safety like they say, it's to stop the staff hurling themselves out to get some relief.
Now you can ask what lucky med student wants some extra experience** calling in a consult? (**experience getting yelled at by a sleep deprived sub-specialist)
The tragedy is the range of emotions from the gut feeling of "Something's not right but idk what..." to "Hey, huh? This doesn't make sense because of (evidence)." And then immediately doubting your concerns because they go "No, no, I know this. I'm the one with more experience." Sighhhhhhhh
So entertaining. Got to do what the boss ordered unfortunately. Despite having clear doubts. Just do what big boss doctor ordered and have a peaceful outcome. It must be so pressurising to have to put up with. Great content as usual Dr. Schmit. Thank you so very much. Kindest regards from England.
I sometimes come up with creative ways to get around certain things I don't agree with. But for things like this it's hard. I prefaced a similar consult to ID with something along the lines of "Hey I'm sorry in advance for this consult but my attending wanted it..."
As an RN this had me laughing hysterically. We have to follow the orders given by a dr but often times we know they don’t make any sense whatsoever. Especially after a few years of experience.😂
I got lucky during my residency training. Whenever the doc ordered something that seemed nonsense to me I just asked "what should I say as justification?" and usually after the 3rd/4th time they'd reply.
‘Hi this is SuperLady with the ICU, I’ve been instructed to consult with cardiology about Mr. Jones. Why wasn’t exactly explained but here’s his info, thanks for the help!!!’
And unfortunately that's how it is sometimes. I tried to discuss this matter with an attending that was notorious for nonsense workup. He said I know that the patient does not require this or this but we do this to protect our assess. In a resource rich country like the US where medicolegal cases are a big deal, yeah you are going to order that unneeded brain MRI or throw an EEG, or just start super expensive empiric antibiotics just to not miss anything. That is typically not the case anywhere else except for the US. Unfortunately the families and lawyers are just waiting for any mistake to sue to make a bank off the hospital. Attendings always think medicolegal here no matter what is the cost while residents who are protected typically think more in a scientific and cost effective way.
as im in the hospital with sepsis right now and here I thought my 104 fever, 50 breaths a minute, and 180 heart rate wasn’t that serious this absolutely made my night
Imagine, you are the patient and you know you are the hot potato....🥴🏥🛏🔥🥔🤷🏼♀️...🤷♂️...🤷... 🥴😤💰🏥💰🤷🏼♀️ And that is actually how it felt to be in that situation.
Oh my god, this couldn't be more accurate. Haha, order an MRI and LP for pt 92 y female who has sepsis after symptomatic improvement with IV ABS on background refractory almost palliative melanoma.😂
