What is a day in the life of a hospitalist like? I'll tell you what it's like.
pager goes off
Me: Dr. Happy here
Other End: I have two consults for you.
Me: Hold on. Let me get some paper. OK, What you got?
Other End: Mrs. Sickasadog in ICU room 6822 for sepsis.
Me: Who's referring?
Other End: Dr. Alveoli.
Me: Pause for a second. Thinking to myself. That's interesting. Dr. Alveoli is a lung doctor and critical care specialist. The patient is in the ICU with sepsis and he wants me to consult? That's friggen wierd.
Me: What is the other consult?
Other End: Mr. Cantcatchmybreath. He's here for respiratory distress. He's in ICU room 6823
Me: Who's referring?
Other end: Dr. Alveoli.
Me: What? Dr. Alveoli is a lung doctor and critical care specialist. He's consulting me for respiratory distress?
Other End: Yes. That's what the chart says.
Me: Who is this? Is this a joke? Seriously. Are you recording this?
Other End: It's Nervous RN.
Me: Seriously. Is this a joke? This has to be a joke. Dr Alveoli wants me to see his patient for respiratory distress?
Other End: That's what the chart says.
Me: I can't believe it. I'll be right there.
Walks up three flights of stairs to the ICU. I, on the other hand, am not exhausted because I work out....I work out...Three nurses and an RT fingering through the chart.
Me: Is that Mrs. Sickasadog's chart?
Others: Yes.
Me: Let me see the order.
Others: We're looking. We can't find it. I swear we saw it. Let us keep looking. Keeps looking over and over and over and over and over again and over and over and over and over and over and over and over and over again.
Another Other: I swear the order is there. I saw it as well. Dr Happy Let me get you some coffee to drink at the nurses station while we figure this all out. Does that sound good?
Me: Yes. That sounds wonderful. I don't have anything else to do on a busy Monday afternoon at 4 pm while we sort out stuff that makes no sense. Oh wait. There it is. It's an order for Dr. Hefty to see. Maybe you asked for Dr Hefty and the operator gave you Dr Happy. I don't know why Dr Alveoli would need me to see her. She's got eight doctors on the case. I don't think I would have much to offer. Do you have Mr. Cantcatchmybreath's chart?
Others: It's right here. Flipping through chart. We can't seem to find that order either.
Me: See. Somebody is messin' with me. It's mess with Dr Happy day. Oh wait, that's everyday. I can't imagine Dr Alveoli would want me to see his patient for respiratory distress. Do you have his cell number?
Others: Yes. BRAVO! I'm shocked! Dr Happy, nobody else ever offers direct physician-to-physician communication. Thank you for keeping nurses out of the middle of urgent doctor to doctor communication.
Happy: I'm not everybody. I'm super Happy. Dials Dr. Alveoli's number. Hey Doc. I was told you wanted me to see Mrs. Sickasadog and Mr. Cantcatchmybreath. I noticed there are eight doctors on the case for Mrs Sickasadog and I can't find the order. Was that a mistake?
Dr Alveoli: Yes.
Happy: How about Mr. Cantcatchmybreath. I was told to see him for respiratory distress. I thought that was kinda odd.
Dr Alveoli: I admitted him this morning. He's not normally my patient. He's Dr Convenience's patient. Would you mind following along?
Happy: No problem. Talk to you later. Click. Rumaging through chart.
Happy: Thinking to self. Dr. Convenience always likes to see his own patients. I wonder if he really wants us to see his patient. Calling hospital operator.
Happy: Could you patch me to Dr Convenience's cell phone?
Ring Ring
Dr Convenience: Dr. Convenience here
Happy: Hi Doc. This is Happy. I got asked to see your patient, Mr Cantcatchmybreath, by Dr. Alveoli. I noticed from the ED (or is it ER?) records, early this morning at the break of dawn that you asked Dr Alveoli to admit the patient. Are you OK with me seeing or did you want to see him?
Dr Convenience: I've got another patient over there. I'll just swing by and see him later.
Happy: Thinking to self again. How selfish is that? You ask the specialist to admit and then you come by later at your convenience? Have you no shame?
I have learned a few things in my 5 years of working at the hospital.
pager goes off. Dials number
Other End: Dr Happy?
Me: Yes.
Other End: Your direct admission with the bilirubin of 25 is here. Can she eat?
I guess it's back to work...
(In case you were wondering, Me, Happy, Other End, Other, Another Others, and Dr Alveoli are fictional. Also, rest assured, no characters displayed here received any compensation, except for a free trip to an amazing beach island, for their incredible story. I also received no compensation for the 14 uninsured ER patients that piled up with acute exacerbation of frozen body syndrome I was asked to admit while waiting to sort out these sordid details. Dr Convenience, on the other hand, is alive and well, lurking in every hospital system all across this great country of ours. Don't be Dr Convenience. Do your job and do it well. And yes, I do let patients with a bilirubin of 25 on admission to eat at will. You know. TO keep them Happy until I have a chance to break the bad news to them. No more food for a week. Because that's what hospitalists do. Just another day in the life of a hospitalist...)
pager goes off
Me: Dr. Happy here
Other End: I have two consults for you.
Me: Hold on. Let me get some paper. OK, What you got?
Other End: Mrs. Sickasadog in ICU room 6822 for sepsis.
Me: Who's referring?
Other End: Dr. Alveoli.
Me: Pause for a second. Thinking to myself. That's interesting. Dr. Alveoli is a lung doctor and critical care specialist. The patient is in the ICU with sepsis and he wants me to consult? That's friggen wierd.
Me: What is the other consult?
Other End: Mr. Cantcatchmybreath. He's here for respiratory distress. He's in ICU room 6823
Me: Who's referring?
Other end: Dr. Alveoli.
Me: What? Dr. Alveoli is a lung doctor and critical care specialist. He's consulting me for respiratory distress?
Other End: Yes. That's what the chart says.
Me: Who is this? Is this a joke? Seriously. Are you recording this?
Other End: It's Nervous RN.
Me: Seriously. Is this a joke? This has to be a joke. Dr Alveoli wants me to see his patient for respiratory distress?
Other End: That's what the chart says.
Me: I can't believe it. I'll be right there.
Walks up three flights of stairs to the ICU. I, on the other hand, am not exhausted because I work out....I work out...Three nurses and an RT fingering through the chart.
Me: Is that Mrs. Sickasadog's chart?
Others: Yes.
Me: Let me see the order.
Others: We're looking. We can't find it. I swear we saw it. Let us keep looking. Keeps looking over and over and over and over and over again and over and over and over and over and over and over and over and over again.
Another Other: I swear the order is there. I saw it as well. Dr Happy Let me get you some coffee to drink at the nurses station while we figure this all out. Does that sound good?
Me: Yes. That sounds wonderful. I don't have anything else to do on a busy Monday afternoon at 4 pm while we sort out stuff that makes no sense. Oh wait. There it is. It's an order for Dr. Hefty to see. Maybe you asked for Dr Hefty and the operator gave you Dr Happy. I don't know why Dr Alveoli would need me to see her. She's got eight doctors on the case. I don't think I would have much to offer. Do you have Mr. Cantcatchmybreath's chart?
Others: It's right here. Flipping through chart. We can't seem to find that order either.
Me: See. Somebody is messin' with me. It's mess with Dr Happy day. Oh wait, that's everyday. I can't imagine Dr Alveoli would want me to see his patient for respiratory distress. Do you have his cell number?
Others: Yes. BRAVO! I'm shocked! Dr Happy, nobody else ever offers direct physician-to-physician communication. Thank you for keeping nurses out of the middle of urgent doctor to doctor communication.
Happy: I'm not everybody. I'm super Happy. Dials Dr. Alveoli's number. Hey Doc. I was told you wanted me to see Mrs. Sickasadog and Mr. Cantcatchmybreath. I noticed there are eight doctors on the case for Mrs Sickasadog and I can't find the order. Was that a mistake?
Dr Alveoli: Yes.
Happy: How about Mr. Cantcatchmybreath. I was told to see him for respiratory distress. I thought that was kinda odd.
Dr Alveoli: I admitted him this morning. He's not normally my patient. He's Dr Convenience's patient. Would you mind following along?
Happy: No problem. Talk to you later. Click. Rumaging through chart.
Happy: Thinking to self. Dr. Convenience always likes to see his own patients. I wonder if he really wants us to see his patient. Calling hospital operator.
Happy: Could you patch me to Dr Convenience's cell phone?
Ring Ring
Dr Convenience: Dr. Convenience here
Happy: Hi Doc. This is Happy. I got asked to see your patient, Mr Cantcatchmybreath, by Dr. Alveoli. I noticed from the ED (or is it ER?) records, early this morning at the break of dawn that you asked Dr Alveoli to admit the patient. Are you OK with me seeing or did you want to see him?
Dr Convenience: I've got another patient over there. I'll just swing by and see him later.
Happy: Thinking to self again. How selfish is that? You ask the specialist to admit and then you come by later at your convenience? Have you no shame?
I have learned a few things in my 5 years of working at the hospital.
- When something doesn't make sense, it's usually because it doesn't make sense.
- Cut out the middle man if you want accurate information. Go straight to the source.
- Communication turns big problems into little problems
- Lack of communication turns little problems into big problems
- Some people are just jerks. You can't change them. Avoid them if you can. If you can't, deal with them and move on.
pager goes off. Dials number
Other End: Dr Happy?
Me: Yes.
Other End: Your direct admission with the bilirubin of 25 is here. Can she eat?
I guess it's back to work...
(In case you were wondering, Me, Happy, Other End, Other, Another Others, and Dr Alveoli are fictional. Also, rest assured, no characters displayed here received any compensation, except for a free trip to an amazing beach island, for their incredible story. I also received no compensation for the 14 uninsured ER patients that piled up with acute exacerbation of frozen body syndrome I was asked to admit while waiting to sort out these sordid details. Dr Convenience, on the other hand, is alive and well, lurking in every hospital system all across this great country of ours. Don't be Dr Convenience. Do your job and do it well. And yes, I do let patients with a bilirubin of 25 on admission to eat at will. You know. TO keep them Happy until I have a chance to break the bad news to them. No more food for a week. Because that's what hospitalists do. Just another day in the life of a hospitalist...)
That's all well and good. While you guys are chatting it up, Ms. Sickasadog with sepsis is missing the 6 hour sepsis bundle that might save her life.
ReplyDeleteYeah, but wow, that exact type of stuff has been going on since i was a medical student in 1973, and now I'm retired. You'd think we'd make SOME progress by now.
ReplyDeletebev MD