Speak Softly and Carry a Big Whooping Stick

My two favorite orders that I have ever written in a patient's chart are:

1. A Sports Illustrated swimsuit issue for a vet with metastatic prostate cancer.
2. A whooping stick.

The first one was great. The patient got his magazine and it made his day. The second even greater.  As anyone with the same last name knows in medicine, if you are a doctor with the same first name and last name as another doctor in your community, your life will be full of headaches.  Mail, orders, faxes, letters, denials, paperwork, requests, prescriptions etc will inevitably get mixed up.

I have an identical twin brother who is also a physician.  We were in internal medicine residency together, separated by a year. As such both our names would show up on a computer entry data base for the clerks to enter when orders required.

For example. I order a basic metabolic panel. The computer system required a physician name to be attached to that order. In spite of having a number attached to my name, on my written order that I wrote, a number that no other physician had, my labs would routinely get entered under his name.

This made morning rounds quite difficult, as new labs that would normally be sent to a very quick and easy part of the patient data system to be reviewed at anytime, would not show up in my own personal system. And they would show up in my brother's system, labs he had no idea what to do with since it was not his patient.  When those labs get entered under any other name but mine, I have no way of knowing when they come back. If a patient is discharged to home and those labs are entered under another name, I have no way to track those labs for followup.

One day on my ICU rotation, I got fed up with the clerk who would continually enter my orders under my brother's name, in spite of my continually reminding them to PLEASE do it correctly.

The nice approach simply wasn't working.  So one day I wrote in the patient chart.....

"Please enter my orders under my name or I'm pulling out my whooping stick"

Needless to say the clerk must not have been happy.  It wasn't long before I had the director of nursing hunting me down telling me that this was not appropriate and wrong and has no place in the patient's chart. And apparently she didn't like my response which was:  

"It worked.  I have received all my lab results since I wrote that order, so I have no regrets"

So the HNIC  went to my residency director. We'll, my residency director and I laughed about it. He told me not to do it again, smiled at each other,  and that was that.  For the rest of the rotation through the ICU, I always got every single lab result back every single day.  I would have no regrets about doing it again. Because the end result was successful implementation of my own patient safety initiative, before patient safety was the in thing to do.  Speak softly and carry a big whooping stick.