Getting ahold of our C/L resident is like trying to reach Rapunzel by phone

[nancysinatra]

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So, today, during my 534-hour call shift on OB-Gyn, I had a patient who was going to get a psych consult. I decided to page the C/L psych resident to see if they would page me back when they went in to see her, so I could go with them, if that was ok. But then it turns out that the first, second, third, and fourth numbers I called (it's a weekend) all led to various forms of busy tone, voicemail, and being put on hold. After awhile I started to wonder if our hospital's phone system was specifically designed to filter out overly eager medical students who might want to attend consults? Eventually, so much time had passed that I actually got paged to attend a ruptured ectopic surgery (this almost never happens--I'm just trying to give a sense of the passage of time here). So I ran off to the surgery and nothing ever happened with me attending the psych consult, which I had very much hoped to do.

Do other med students try to attend their patients' consults, or is it just me? Does anyone actually succeed in getting AHOLD of these consultants and having them remember to page you? If so, what's your strategy? During various rotations I've called GI, pulm, psych, derm, pain, neuro, and multiple other services--never to any avail, not even ONCE! What's wrong with me? Is it annoying to the residents who do the consults to get bugged by the med student?

 

[Faebinder]

MMmm...

Consults are usually handled during the week, not the weekend unless it's an emergency service. Emergency services are generally: Trauma (Not same as General Surgery which can include minimally invasive surgery such as a Nissen or a Heller), OBGYN, and Critical Care services (Pulmonary, Anesthesia, PICU/MICU/SICU and again Trauma).

Incase of a Psychiatric emergency over the weekend, you page the Psych ER, otherwise it waits till Monday.

Hospitals cant afford to have all the services available in the weekends and those services dont want to be available in the weekend.

 

[sunlioness]

We do psych consults on the weekend. It's not quite the same as during the week in that it's the on call resident who does them as opposed to the C/L team. But they still happen. To the OP, I personally wouldn't have minded a med student coming with me on a consult. But aside from the students actually assigned to me, no one ever asked to do so.

 

[Anasazi23]

Do other med students try to attend their patients' consults, or is it just me? Does anyone actually succeed in getting AHOLD of these consultants and having them remember to page you? If so, what's your strategy? During various rotations I've called GI, pulm, psych, derm, pain, neuro, and multiple other services--never to any avail, not even ONCE! What's wrong with me? Is it annoying to the residents who do the consults to get bugged by the med student?

Sounds like it might be a hospital problem. Most residents at my hospital page back within minutes of the page request. Many hospitals do have psych consults on the weekends. But it's usually lower on their priority list. If it's one resident handling the ER and floors, and the ER is hopping, then you might not get a page back for a while. That said, make damn sure it's ok for students to page for consults. You'll get crucified by a senior resident on the receiving end in some hospitals for that...especially if it's the weekend and it's not emergent.

 

[nancysinatra]

Wait--I think my question might not have been clear. I wasn't calling to ARRANGE a consult. That was done by my intern. I know the C/L resident paged him right back at that time, as I'm sure they always do. When I've had to arrange consults myself, I've always had that experience.

My question was if other students have asked the consulting residents to let them come with during the consultation. As in, just tag along. I started doing this at an away hospital where I was doing part of my medicine rotation. My patient was getting a GI consult and my attending told me to make sure I was present for that consultation, because I would learn a lot. So I attended it, and I did! Ever since then I've wanted to be present for other consultations on my patients, assuming it's ok with the consultant and the patient. I always ask my intern first. The problem is, I can't get the people doing the consultations to remember to page me when they're about to enter the room! It's totally understandable--I would probably forget to page the med student too.

Today the problem escalated because in this case, I couldn't even get through to the resident using our hospital's phone and pager system. My intern had no problem doing so, just me. I certainly would have been more aggressive and diligent about this if I'd been trying to actually arrange the consult--but I wasn't, so when the surgery came up I gave up.

Really, I just thought maybe this bad luck was a message via the phone system telling me that I should leave these consultants alone! ;-) But hmmm, I really would like to attend some of the consults. I actually did make it to one geriatrics consultation once, and it was very helpful. It helped put together the whole picture of what was going on with my patient.

 

[OldPsychDoc]

Sounds like you're a diligent med student who had a moment of bad luck with hospital communications. Tough break--probably would've made the hell of OB/GYN more bearable.

From my perspective, I'd have no problem with a med student on another service asking to tag along on a consult for a patient they were following. Some of the problem may have been the weekend aspect of the situation. As a resident, we'd be the only psych doc in the hospital, so a consult would drift way down our list of priorities, and we probably would just see it to get it done, and not be thinking about the primary team's med student. In my current situation, it's kind of the same deal. We do staff cover weekend consults, but we're pretty focused on getting it done and getting home, so sorrry, but unless you're hanging right outside the patient's door waiting for me, I'm probably going to forget to include you.

 

[nancysinatra]

From my perspective, I'd have no problem with a med student on another service asking to tag along on a consult for a patient they were following.

Oh, good--I always figured it would be a person-by-person preference as to whether consultants would mind letting a med student tag along. It's just a string of bad luck I've had, probably.

I think the reason this bothers me a bit is that it takes some courage every time to pick up that phone as a med student who hardly knows anyone in the hospital! Our job involves continually approaching people who don't know us at all--people who can detect our lack of experience from a mile away--and asking them for favors or information. I know it's all part of the educational process, and everyone goes through it, but I always feel SOOO unprofessional during those moments. I'm on a different rotation every month or 6 weeks, the interns within each rotation change one week, the residents change the next week, the attendings barely get to know us, the nurses NEVER know us... As soon as I get good at working with one team or person, the group will change! Or I'll get good at a rotation, just as it's about to end. Then I call about these consults and it seems like maybe it's not the right thing to be doing--ugh! I just want to be doing things enough that I can get really good at them and have some familiarity with my job...

I can't wait for residency, and getting to work with the same group of people, within the same system, with at least some consistency.

 

[Anasazi23]

Unless the resident is just nasty, no one will fault a medical student for simply wanting to watch you perform your specialty. If they give you attitude for it, then they're either uncomfortable with themselves, overtired and cranky, or just rude. Write them off and move on.

I'd never turn away an MS looking to stand in on a consult with me.

 

[Chrismander]

What's the Rapunzel connection? Wasn't she the girl with the long hair in a tower or some such thing?

 

[Faebinder]

What's the Rapunzel connection? Wasn't she the girl with the long hair in a tower or some such thing?

Not much into abstract thinking eh?

Meaning why is it so hard to get a hold of the resident... Rapunzel was hard to get to because she was in a high round tower with no stairs or doors and just a single window at the top.

 

[RookieRoo]

In my med school I had no problem getting a hold of consultants when I wanted to tag along. One tip I learned in residency. In our hospital you typically "tag" your page with your pager number. For example, if you are at extension 1111 and your pager number is 555-6789 you would enter 1111*6789. The purpose is to let the person you are paging know that the individual trying to reach them is likely an MD (or student with an assigned pager). Some residents are much more likely to return a tagged page promptly. You can always ask your current intern if this is the custom where you work. (it may explain why her pages get returned promptly and yours do not)

 

[nancysinatra]

Not much into abstract thinking eh?

Meaning why is it so hard to get a hold of the resident... Rapunzel was hard to get to because she was in a high round tower with no stairs or doors and just a single window at the top.

Yeah, that was exactly what I meant. Also I was making fun of myself for honestly hoping I was EVER going to figure out this medieval hospital communications system we have. It's not much different from that day when I thought I'd try to figure out where everything is in the supply room.

Today was a huge improvement though. All my pages got returned, and I got to discuss my patient with two different consults so all was great. Plus I contributed to figuring out what was going on with this patient. We changed her meds based on something I thought of and brought up via a page! Yay!

 

[Wednesday]

No consults on the weekend! That's all we do! (at least at two of our sites). Where are these places where people don't want to leave AMA, get delirious, get agitated, or become medically clear after a suicide attempt on Saturdays or Sundays?