Difficult Lymphoma Case

[thecarbonionangle]

So when your radiation pneumonitis patient is hypoxemic and requires inpatient hospitalization, you admit them to your service?

YOU KNOW THE THING!!!!

---

Members don't see this ad.

 

[elementaryschooleconomics]

Sometimes, if I'm feeling sassy, I'll even start some Bactrim for PJP prophylaxis.

 

[medgator]

So when your radiation pneumonitis patient is hypoxemic and requires inpatient hospitalization, you admit them to your service?

Just got off the phone yesterday with one of the pulm CCM folks to talk about one of my N3 pts who came in hypoxemic 6 weeks after completing tx. Everything else excluded so i told him to hit the pt hard with 1 mg/kg for at least a month and then reeval. Pulm definitely appreciated my input even though i wasn't formally consulted on the pt.

If you come across as a technician, that's how referrings will treat you

 

[medgator]

Radiation pneumonitis is a diagonals of exclusion. Should they need to be inpatient to be worked up, we'll defer to the team. Otherwise we'll work them up, and then start roids. Kinda like when we get consulted by the inpatient team bc nsg didn't tell em how to taper roids. Sorry you work with ****ty radoncs. At the same, maybe that don't return your call for a reason.

Sometimes they forget to put the pt on dex at all.... Or maybe they write for prednisone. I've seen both

 

[Lamount]

So when your radiation pneumonitis patient is hypoxemic and requires inpatient hospitalization, you admit them to your service?

I’ve learned the hard way not to trust the inpatient oncology team when one of my patients is admitted. Things get missed. Big things. Where I work, the inpatient onc attending rotates between medoncs with different disease sites. One week it could be a sarcoma doc, the next a breast cancer doc. They don’t know my patients from Adam. I will frequently have daily conversations with the inpatient NPs/PAs and tell them which antibiotics to prescribe, hold vs. continue A/C for the patient with the PE and brain Mets, which studies to order and who to consult... and they are usually grateful for the guidance.

 

[IRattending2021]

Radonc at where I work is extremely knowledgable and available. The best way to impress another doc is to be familiar with their techniques and considerations.

 

[elementaryschooleconomics]

I’ve learned the hard way not to trust the inpatient oncology team when one of my patients is admitted. Things get missed. Big things. Where I work, the inpatient onc attending rotates between medoncs with different disease sites. One week it could be a sarcoma doc, the next a breast cancer doc. They don’t know my patients from Adam. I will frequently have daily conversations with the inpatient NPs/PAs and tell them which antibiotics to prescribe, hold vs. continue A/C for the patient with the PE and brain Mets, which studies to order and who to consult... and they are usually grateful for the guidance.

I once had a MedOnc call me for a mutual patient and ask me what chemo and what dose I wanted them to give (I wish I was exaggerating, but that phone call is burned into my brain).

However, where I am at least, bad doctoring is the exception, not the norm. I once had a patient with what we presumed to be severe radiation pneumonitis (and other comorbidities) who needed to be intubated. We obviously sent them to the MICU.

We make a point of trying to manage our own side effects for as long as we can, until it's not in the patient's best interest. Prostate patients with ED refractory to medication? Obviously, go see Urology. I definitely don't know what's in between Viagra and a penile implant.

While RadOnc may fight with IR about RFA until the end of time, there are about 784 things they can do that I can't. Probably more.

@JoeBiden69, from your post history, it seems like you're a Hospitalist who often works on Dumping Grounds™. Sorry about that. When I was an intern staffing the IM inpatient wards virtually continuously throughout the year, I admitted an absurd amount of what I considered to be ridiculous patients which should have gone to other services. I will never forget the 10PM admission from the Ortho PA of a patient they wanted to take to the OR in the morning, and the justification for the Medicine admission was something like "rash r/o infection"...when really the PA just wanted to go home.

While I know they exist, I imagine we're not going to hear from the RadOncs who punt any and every complication elsewhere. The RadOncs who come spend their free time on SDN are not the ones who seem to "check out" when 4pm rolls around...