Most ridiculous DUMP!

[Substance]

We all know that internal medicine is the dumping ground for basically every other service. If there's an old person with a lot of chronic medical problems, every other service tries to pawn it off to medicine.

Share your stories of the most inane and insane dumping that you have encountered. I will start:

92 y/o woman comes to ED with LUQ pain. ED consults Gen Surg for possible diverticulitis, which is proven by CT. Gen Surg consults medicine for "mental status changes" though they already have the primary diagnosis, and wants medicine to admit. Medicine sees the patient anyway. Patient does not speak English, but Portuguese. A translator is found. Patient is completely oriented. Medicine did not admit.

In essence, we were consulted for a patient with a diagnosis of Portuguese.

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[jdh71]

I always like the ortho dumps.

Had a lady who fell, broke her hip while drinking (who doesn't right?!), she was 50 something, no PMHx to speak of, no medications for chronic medical condition, ortho blocks saying, "She might withdraw, admit to medicine"

And while the next scenario is not strictly a "dump" in the beginning, for all practical purposes it is, and the guess who is the bad actor? Yup, surgery. Usually happens on a friday when you're in the MICU, trainwreck comes out of the OR where surgery did some fancy (read: cut some stuff out, reconnected some stuff in weird places, probably won't work, but what the hell . . .) surgery, and they consult MICU for "vent management" and then precede to disappear for the rest of the weekend. When you are paged, you will remind the nurse that this is a surgery patient, and the nurse will tell you surgery told them to call you . . . then about 4-5 days later surgery will attempt to transfer service, because: "There is nothing surgical going on". Most academic MICU attending will accept, probably because, while they may do most of the intellectually heavy lifting, practically they are not bothered by this themselves. And surgeons try and claim they are all "critical care" doctors

 

[sluggo]

Patients are people, not "dumps". If another service cannot or will not take care of a person, and an IM doctor can, then that IM doctor should. End of story.
How would you like it if your mom was in a hospital and someone called her a "dump". We need to take care of all patients as best we can and not worry about what other services do.

 

[BlazerMed]

I always like the ortho dumps.

Had a lady who fell, broke her hip while drinking (who doesn't right?!), she was 50 something, no PMHx to speak of, no medications for chronic medical condition, ortho blocks saying, "She might withdraw, admit to medicine"

And while the next scenario is not strictly a "dump" in the beginning, for all practical purposes it is, and the guess who is the bad actor? Yup, surgery. Usually happens on a friday when you're in the MICU, trainwreck comes out of the OR where surgery did some fancy (read: cut some stuff out, reconnected some stuff in weird places, probably won't work, but what the hell . . .) surgery, and they consult MICU for "vent management" and then precede to disappear for the rest of the weekend. When you are paged, you will remind the nurse that this is a surgery patient, and the nurse will tell you surgery told them to call you . . . then about 4-5 days later surgery will attempt to transfer service, because: "There is nothing surgical going on". Most academic MICU attending will accept, probably because, while they may do most of the intellectually heavy lifting, practically they are not bothered by this themselves. And surgeons try and claim they are all "critical care" doctors

This is why I'm thankful our hospital has a separate ICU where the surgeons consult an anesthesia critical care team for vent management.

 

[jdh71]

Patients are people, not "dumps". If another service cannot or will not take care of a person, and an IM doctor can, then that IM doctor should. End of story.
How would you like it if your mom was in a hospital and someone called her a "dump". We need to take care of all patients as best we can and not worry about what other services do.

Save your sanctimony for someone else clown

When one group of "doctors" fully capable of taking care of a patient, turfs the patient to another group of doctors out of laziness, then this is a dump. Are you stupid, or merely unable to see the obvious.

No one is talking about the 90 y/o with CAD, DM, HTN, COPD admitted to medicine with a hip fr# - this makes sense. Please pay attention to the context, and take your ******ed crusade somewhere else.

 

[Cards21aceking]

Save your sanctimony for someone else clown

When one group of "doctors" fully capable of taking care of a patient, turfs the patient to another group of doctors out of laziness, then this is a dump. Are you stupid, or merely unable to see the obvious.

No one is talking about the 90 y/o with CAD, DM, HTN, COPD admitted to medicine with a hip fr# - this makes sense. Please pay attention to the context, and take your ******ed crusade somewhere else.

as always, glad to have you back jdh.

 

[Substance]

Patients are people, not "dumps". If another service cannot or will not take care of a person, and an IM doctor can, then that IM doctor should. End of story.
How would you like it if your mom was in a hospital and someone called her a "dump". We need to take care of all patients as best we can and not worry about what other services do.

For a guy named sluggo, you sure are quick to the trigger.

It's not the patient that's the dump. The dump is a VERB. It's when another service tries to send a medically mundane yet complicated patient to general inpatient medicine because they don't want to deal with the patient's chronic medical and social issues, even if the admitting illness is best treated by their service.

Go walk over some eggshells or something, sluggsy.

 

[mig26x]

Patients are people, not "dumps". If another service cannot or will not take care of a person, and an IM doctor can, then that IM doctor should. End of story.
How would you like it if your mom was in a hospital and someone called her a "dump". We need to take care of all patients as best we can and not worry about what other services do.

that's the problem, medicine service shouldnt be admitting people because other services cannot or will not take care of a person, especifically if they will not take care of a person even though the primary problem is not a medicine problem.

medicine services are pretty busy as of rigth now to be admitting patients with fractures or SDH just because the ortho or neurosurgeon doesnt want to go to the hospital at 11pm at night.

medicine service is not a babysitting service for orther services.

the other day surgery saw a pt with acute cholecystitis and said they wouldnt operate until pt more stable under medicine service as the primary team. My attending called the surgeon and told them--> admit the patient under surgery and medicine will follow as a consultant.

 

[mig26x]

For a guy named sluggo, you sure are quick to the trigger.

It's not the patient that's the dump. The dump is a VERB. It's when another service tries to send a medically mundane yet complicated patient to general inpatient medicine because they don't want to deal with the patient's chronic medical and social issues, even if the admitting illness is best treated by their service.

Go walk over some eggshells or something, sluggsy.

I think he's a surgery or ortho resident.

 

[docdaname]

I think he's a surgery or ortho resident.

In one of the hospitals we rotate through higher ups between medicine and ortho, apparently, have come to this agreement: any patient with a hip fracture is admitted by medicine. regardless of PMHx.

another hospital, 19 yo girl with cholecystits. no other problems. on our service for 1 day, then went to the OR for the choley. I think they just didnt want to have to dictate the H & P.

 

[drfunktacular]

80-something year old guy who lives alone with no caretaker, brought to ER by a friend who visited him and found his right foot to be NECROTIC. Not cellulitis, not an ulcer, but FRANK. NECROSIS. to the ankle.

Surgeon sees him in the ER and the pt says "DON'T CUT OFF MY FOOT!" Surgeon says, "he doesn't want a surgery, he has capacity to decide. Admit to medicine for IV Abx" (aside: ???????).

We talk to him for 2 minutes in which he cannot tell us where he is, what the year is, why he is in the hospital, or what his treatment alternatives are.

Guess who still admitted him???

 

[ResidentMD]

80-something year old guy who lives alone with no caretaker, brought to ER by a friend who visited him and found his right foot to be NECROTIC. Not cellulitis, not an ulcer, but FRANK. NECROSIS. to the ankle.

Surgeon sees him in the ER and the pt says "DON'T CUT OFF MY FOOT!" Surgeon says, "he doesn't want a surgery, he has capacity to decide. Admit to medicine for IV Abx" (aside: ???????).

We talk to him for 2 minutes in which he cannot tell us where he is, what the year is, why he is in the hospital, or what his treatment alternatives are.

Guess who still admitted him???

Out of curiosity, if its a caretaker, and its an emergency (which it appeared to be), didnt they have to do an amputation? Did they try to find someone who could give consent?

 

[drfunktacular]

Out of curiosity, if its a caretaker, and its an emergency (which it appeared to be), didnt they have to do an amputation? Did they try to find someone who could give consent?

I said he lives with NO caretaker... he was dropped off by just some friend who happened to stop by. I agree that they should've done the amputation, but I don't get to run the surgery service...

They did eventually do it but only after we had him on our service for 2 days wasting time getting a formal psych consult and threatening to get an ethics consult as well...

 

[ResidentMD]

I said he lives with NO caretaker... he was dropped off by just some friend who happened to stop by. I agree that they should've done the amputation, but I don't get to run the surgery service...

They did eventually do it but only after we had him on our service for 2 days wasting time getting a formal psych consult and threatening to get an ethics consult as well...

Okay - yeah but this is very unfortunate...almost hard to believe, yet true.

 

[indiamacbean]

lock this thread. this is a waste of time and is only going to lead to bad blood between services.

 

[mig26x]

lock this thread. this is a waste of time and is only going to lead to bad blood between services.

why lock it? its the reality of internal medicine. we babysit for other services.

bad blood already exist and its been there for years because of this dumping stuff.

 

[gutonc]

Patient with widely metastatic GIST, not responding to anything. Comes to ED (3rd visit in 3rd ED in 3 days) with 3 weeks of rectal bleeding, no fatigue, no DOE, no CP, no orthostasis, Hct unchanged since last clinic visit 4 weeks prior, has clinic appt in 36 hours. Surgery consulted, says, "rock solid stable, no indication for urgent surgical management, nothing to be done, admit to Onc and we will follow." ED resident calls me for admission, I say, "how convenient, I wish I could admit to another service. Send him up, I'll discharge him from the floor if he looks OK." Fortunately, the patient was wise and refused admission.