Here's to stopping the whining when you take an admission.

Discussion in 'Internal Medicine and IM Subspecialties' started by bariume, Apr 19, 2004.

  1. bariume

    bariume Member
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    There is nothing more classy and professional than a resident who takes an admission to his/her service with grace and confidence. On the contrary, there is nothing more pathetic than a resident who whines when he gets the admission, and then tries to block it in a futile attempt. Here's to sucking it up, and doing the job right. I would say that despite how you take it, the outcome is nearly always the same (meaning the patient ending up on your service.) So be like the men on the Titanic and take it with pride and do your job.
     
  2. kinetic

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    Yeah, it sure is classy when people just shut up and take it up the rear. When that happens, bask in your professionalism. Don't be pathetic and note deficient work-ups, just be a man and take it with pride. Oh, and do your job, unlike bariume. This thread is amazing because it not only reflects complete vacuousness, but also a self-centeredness that is amazing to see. Congratulations!
     
  3. bariume

    bariume Member
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    I think you have misread my post. Do you think you are projecting yourself on it? Sounds like it. I've read your other posts.
     
  4. kinetic

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    bariume, I apologize if I took your post wrong. I probably acted "knee-jerk" (or just "jerk") when I read your post. I took it as "I'm gonna get my patient onto your service whether you like it or not and you'll like it!" (because of the "tries to block it in a futile attempt ...[but] the outcome is nearly always the same (meaning the patient ending up on your service)". Anyway, I hope you don't act hypocritical when it's your turn to accept the patient. Some people (I'm not saying you, because I don't know) are all about giving patients to others, but when it's time to accept patients they try to turn into a brick wall. (That's even within the same specialty.)

    (Never let it be said that I don't retract my words when I'm wrong.)
     
  5. bariume

    bariume Member
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    I agree with you in that I don't condone incomplete workups and rush triaging to services. That is a common problem in all hospitals. I know of a few ED attendings who are a open flood gate when they come to work. And that sucks when that happens.

    Anyways, my post was actually about residents who set a good example for us to emulate. I am not saying that I, myself am a model example, but that I admire those who can take patients without balking. It's an attitude that I'd like to cultivate for myself.
     
  6. AJM

    AJM SDN Moderator
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    The issue is not whether a resident will take patients without complaining, but rather if the resident knows when it's appropriate to try to block and when not to. There are certainly residents who try to block every admission, and ones who will accept every admission -- neither of whom I think are good examples to emulate. (the residents who accept every single admission without question often tend to be ones who lack confidence in their own abilities to assess patients). The best residents to emulate IMO are the ones who will gracefully take appropriate admissions, and when there are ones they feel are inappropriate, they work with the ER/transferring service in a collegial manner to figure out the most appropriate treatment plan or treating service.

    Just my 2 cents....
     
  7. BassDominator

    BassDominator Senior Member
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    Exactly why I ran away from internal medicine....

    I love taking care of patients. I just hate having unstable patients admitted to my service, who I know next to nothing about, and who haven't had the appropriate workup elsewhere.

    And we wonder why the patient is upset and uncooperative? I'd be if I was asked the same questions and continually re-examined by half a dozen doctors who weren't doing anything for me. I know this is more the exception than the rule, but this just shouldn't happen PERIOD. No excuses.

    I always keep my mouth shut and take the admission.... because patient care is job #1. If my resident wants to fight, I'm more than happy to let him/her.
     
  8. flighterdoc

    flighterdoc Rocket Scientist
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    "I'm sorry Mr/Ms X that I have to ask you all these questions over again. But, I'm going to be your doctor here, and I'm going to do everything I can to get you well."
     
  9. BassDominator

    BassDominator Senior Member
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    Good point. That's what I tend to say. I'm just so tired of having to say it.... but what really burns me is the lack of continuity of care. I don't see why it's so hard to transfer a patient in reasonably stable condition (unless they're going to the ICU), with the appropriate stat labs/tests/orders, and with a verbal signout or transfer note.

    I can't tell you how many times I was told by the ED I was getting a stable patient.... Then, when the patient gets to the floor, they turn out to be in DKA, with an anion gap and ketones up the wazoo, maybe half a liter of saline in at most, no insulin drip, a non-functional IV.... you get the picture. I'd much rather find this out from the ED than from the nurse paging me in a panic. Am I wrong to be upset here?
     
  10. flighterdoc

    flighterdoc Rocket Scientist
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    No, but unfortunately there are slackers everywhere.
     
  11. BassDominator

    BassDominator Senior Member
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    I totally agree. Yes, most of the time the whining is total BS, but sometimes we earn the right to stand up for ourselves.
     
  12. Bobblehead

    Bobblehead Senior Member
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    In my particular hospital the saying is very true that **** flows downhill and medicine is most definitely at the bottom. However we're also best equipped to manage patients on the floor that are not ICU-worthy. Due to the high volume our ICU criteria is fairly high and a lot of fairly unstable patients are commonly managed for the duration of their stay on a general medicine ward alongside the hip fracture with a few too many medical problems and the suicidal patient who took a few too many pain pills and is sleeping them off and the person with possible stroke and with a UTI and is past the 3 hour time period.

    It is a resident's god-given right to whine. But in all honesty most patients get better floor care on medicine than they do on other services and some patients simply can't go home for one reason or another. And in the end that's what we do, take care of those patients that no one else can be bothered to treat.
     
  13. Hotsauce21

    Hotsauce21 Huh?
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    suck it up, man. and take the admissions.
     
  14. dbiddy808

    dbiddy808 Senior Member
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    I totall disagree with all that was written above.

    THERE IS NOTHING MORE SATISFYING THAN A SUCCESSFUL BLOCK! I like to refer to myself as the Manut Bol of internal medicine. Blocking is what I live for!
     
  15. apma77

    apma77 Senior Member
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    this is one big reason i could never do IM or general surgery...constantly getting dumps from other services and the ER

    come one come all
     
  16. Annette

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    . . .that I whined about doing the 7th admission of the night on someone who really is a social admit, screwed by radiology stating may be infiltrating Ca vs. gastroenteritis on the CT report. After having to reassure 2 out of 3 patients in for ca workups, earlier in the day that they may not have cancer (my bets are all 3 do), with having to cope with a 3rd year medical student who doesn't know how to do an exam let alone write a note, trying to find time on how to work up serum eosinophillia, and writing notes on 8 patients, having to clear out my pager three times because it has run out of memory from nurses paging me about "so and so's blood test is done, and oh, bye the way his sugar is 523," and not to mentioned being reamed twice by the senior resident and the attending for not putting in a f*&king note about having reviewed a f&*king nl cxr at three am, my sphincter should have absolutely NO TONE and I shouldn't even feel anything.

    Oh, yeah, and thanks for scheduling me for 3 nights of hell in 5 days. It isn't an internship year unless you are completely crushed by the middle of it, is it? Can't wait to be a senior so I can sleep through the night and yell at my intern for stupid ****.
     
  17. Linie

    Linie Senior Member
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    We have a rule with the ED that we get to evaluate the patient in the ED before they are rocketed to the floor. To avoid long delays, we have to see the patients within one hour of being notified about them. It works out okay.
     
  18. kinetic

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    LOL, finally -- some honesty! I will pit my patient-blocking skills against you any time, anywhere. The ultimate test: blocking a nursing home patient. Let's go! Time for you to meet the hand!
     
  19. VentdependenT

    VentdependenT You didnt build thaT
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    Give up some good blocking tactics why don't ya.
     
  20. dbiddy808

    dbiddy808 Senior Member
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    My program is a community one, so we have three options. The first and most important option may not exist at some programs, so forgive me.

    Option #1 - Determining if the attending has "team care" privilages.

    The first thing I do is check my list of all approved attendings. About 1 in 20 potential admissions will not be on the list. This is golden because if they are not on the list, then there is no need to even evaluate the patient.

    Option #2 - Determining if the patient even needs to be admitted.

    Early in my residency I discovered that just because an ER doc thinks a patient needs to be admitted it doesn't mean sh#t. Before looking at old records, starting writing your H + P, evaluating labs, looking at x-rays and CTs, getting an extensive inteview, I look at the patient and talk to them for 2-3 minutes. You would be suprised how incompetent the ER docs can be at times. Often times the only impression the attending has is what they have heard over the phone from the ER doc, so their impression is clouded. If I do my initial evaluation and have a suspicion that it is a BS admission, I confirm this by doing a thorough evaluation of all available data, then I call the attending and present it in a more favorable light. Most attendings will put more faith what a medicine resident tells them than in what an ER doc says.

    Option #3 - The oh-so-sweet Turf.

    This is what will save you more than anything, because often times option #1 and #2 may not be viable options, so here is a quick run-down. Sick patients go to the MICU (this all depends on what data you have and how you present it to the MICU attending). Remember that nursing is something to consider. Many floors cannot handle drip titration. Frequent lab draws are also not an option on certain floors. And finally, patient care comes first, so this is often a way of presenting your case, ie "I think that this patient is very sick and would be better managed in the ICU".

    Complicated cardiac patients go to the CCU (unfortunately in my program this does not apply as floor teams manage CCU patients).

    Surgical patients go to the surgical team. This one can be difficult, especially after seeing how the surgeons manage patients with multiple medical problems, but it is a viable option.

    Complicated neuro patients belong in the Neuro ICU (all depends on how you present this option to the neuro ICU attending and if you are able to get a neurosurgeon to assume care). This means hemorrhagic strokes, t-PA candidates, hard to control seizures, etc....

    And need I say that any pregnant woman with any problem should be managed by the Ob-Gyn team (usually very easy as these residents are usually very gung-ho and not too bright).

    All in all, it is all about realizing the options and presenting your case well.

    I hope that this helps. And I welcome any additional pointers as it may help the future residents out there, and it may help me as I still have a year of residency remaining.
     
  21. kinetic

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    If you had read my thread on "Ahh ...the ED" in the Surgical forum, you would not say things like this.

    http://forums.studentdoctor.net/showthread.php?t=110312

    "Rise, my pretty thread!! Rise!!"
     
  22. jashanley

    jashanley Senior Member
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    Funny senior residents don't get to sleep very much either. They get the admissions at least at my institution. Yelling at your intern only creates a cycle of anger and annoyance. Why not try to break the cycle. It might make a better working environment in the future.

    Being a part of the EM and the IM sides, I hear about all the whining from the medicine residents and then I hear dumb the ED is......I say you chose this job. If a patient needs to be admitted for any reason, social or medical, suck it up and take the admission. The ED attempts to set the tone for the care of the patient. Sometimes the workup is in the wrong direction, and everyone says how dumb the ED is.....what they don't realize is the hundreds of patients who were admitted with the proper workup or went home that you all never see.
    Yes, I do agree there are some dumb EM docs and there are some very whiny IM residents. However, I have found that most EM docs do a very good job despite seeing more patients in an 8 or 10 hour period than you might see in 2-3 days of clinic.
    I also have worked with IM attendings and residents who are gracious (even at 3 am), intelligent and provide unbelievably good care. If a patient is in DKA, and is put on the floor (as mentioned above) suck it up and get the put into the ICU. It isn't that bad. It happens at my VA, where medicine runs the show in the ED. Don't always blame the dumb EM doctor, because IM and surgery both make the same mistakes.
    I do think that a 4 am admit sucks and I hate getting them, but the patient has been deemed to need to be admitted and they deserve our evaluation and attention. If we waste time whining, that is less sleep we might be getting later on.
    Many patients get admitted to services to be monitored without any necessary intervention, ex. serial abdominal exams for r/o appy. They may not end up having the appy but they needed to be watched closely for a period of time and it was safer for the patient to stay in the hospital than go home and perforate.
     
  23. Annette

    Annette gainfully employed
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    I'd LOVE just getting the admissions and the odd call from the floor when the nurse isn't happy with the intern! Hell, I'd love it if the ED even just went in and LOOKED at the patient before sending someone very sick to the floor! I always dread when a certain senior resident is in the ED because he is notorious for just looking at the triage presenting complaint and deciding what to do with the patient. I agree that MOST of the ED physicians are caring and competent, however there are also a few killers as well in any specialty.

    As for the ED doc seeing more patients in one day than I see in 2-3 days of clinic is crap. The interns in the ED where I'm at are expected to see 15 patients, on average, in a 10 hour shift. I have to see 8 hospitalized patients AND 6 patients in clinic in a 10 hour period (which usually stretches to at least 12). I have to make a diagnosis, not just a traffic decision. I have to answer all sorts of questions, like "am I going to die?" I have to explain to a patient that what she thought was gout is actually ischemia, and she is going to lose her leg.

    "If we waste time whining, that is less sleep that we will get later on" (or there abouts). My post was 16 hours of sleep post call. I didn't sleep at all on that call. I didn't have time to whine let alone sleep. Only on my own time was I able to vent.

    I've done my rotation in the ED. I had even considered emergency medicine as a career. I know the ED works hard. I also work damned hard. My whole rant was about how overwhelming internship can be, and at a certain point, if you don't complain some, you will crack. Oh, by the way, how did then 80 hour rule get instituted? By people "whining."
     
  24. DrQuinn

    DrQuinn My name is Neo
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    Annette- Have you decided to stick with IM? I miss ya over in the EM Forums... :(

    Q, DO
     
  25. kinetic

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    "You chose this job" is the last bastion of the desperate. It is the poor man's rationalization for pathetic performance. Non-ED physicians are not angry about seeing patients. They're angry about seeing patients that have been evaluated in a half-assed manner (if at all, on occasion), with an incomplete workup, and a shot-in-the-dark diagnosis. Is this every patient that the ED gives out? No. But it's a substantial minority, and at every institution. And the typical excuse is "you chose this job ...so suck it up and take the admission." Hey, just because YOU think the person should be admitted, doesn't mean I can't evaluate the patient and decide otherwise.

    I guess your "suck it up" mentality is a one-way deal (unsuprisingly). When the ED is doling out patients, everyone has to "suck it up", but when the other services decide to refuse the patients or want a better initial evaluation it's "hey, hey, hey, that's not my job!!" This is why people hate the ED - because of putzes like you. When people come and refuse patients, why do ED physicians fight so hard? Shouldn't you "suck it up" and deal with the patient because "you chose this job"?

    And don't even try to compare the ED to clinic patients. Patients in specialty clinics (Surg, IM, etc) may have uncomplicated problems - as do many ED patients. But the ED just deals with one thing: the CC. In clinics, you deal with the CC, then work your way down the entire PMH (in terms of preventative care, follow-up care, etc.). Do you guys see a lot of patients? YES. The reason? Because you're not by any means treating the patient or dealing with chronic problems (which are far more of a pain in the butt that dealing with an acute issue).
     
  26. Foxxy Cleopatra

    Foxxy Cleopatra Surgery Resident
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    Hey Annette-

    I'm right there with you. Being at the end of my 1st year in surgery, your quote pretty much sums it up.

    Good luck- wish I had some good, optimistic advice but I don't so I just wanted to say there are others of us out there thinking the same thing as you.

    -F.C.
     
  27. jashanley

    jashanley Senior Member
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    Did you even read my post or did you read half and then start writing.
    I can't believe you would stoop to calling someone a putz. Unbelievable.
    I will refrain from name calling. I was saying that we are all mature and whining doesn't make the admission go away. I will tell you that I take pride in giving my patients the best evaluation and care I can. I don't call surgery without giving my patient a full evaluation. Being a combined resident (medicine and emergency medicine) I both give admissions and take them. I try to take them graciously and only those that should be on my service. Most patients should be admitted when they call and to whom is the next question.

    Being a combined resident I have had the experience of working in the ED and in the clinics. SO I do care for the chronic conditions (HTN, DM, CAD, COPD, etc....). Before you make an asinine statement about me, check the facts. I also make an effort to address their chief complaint in the ED but also I try to continue the education about their diabetes, smoking, even weight loss. I also make sure their other conditions are under control. So I don't just address their CC. I don't like being pigeon holed. You don't work with me and don't know me. So don't make assumptions. I make none about you. However, based on your bias and statements I probably could, but will refrain and I don't judge people by their words alone.
     
  28. kinetic

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    And all I was saying was it works both ways. You're a combined resident? Fine. Then you know that you get people from the ED who don't need to be admitted and you know what ensues is a lame battle. "You must take him - I think he's sick enough to be in the hospital!" "Well, I evaluated him and I disagree!" "Well I'm not discharging him!" "Well I'm not admitting him!" If you're going to act all "be mature and accept the admission ...it's your job!" then I'm going to say "be mature and accept the rejection ...it's your job!" See how parity works?

    P.S. If you see patients in clinic and the ED, then you know that the ED does not deal with chronic issues. If you want to pretend that an ED visit is the same thing as a clinic visit (and it's not supposed to be, so I'm not implying that it should be) then you're sadly mistaken. All I said was that there's a reason ED docs see more volume that a non-ED doc -- which, being a combined resident, should be quite apparent to YOU.
     
  29. MustafaMond

    MustafaMond K-Diddy M.D.
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    :thumbup: :thumbup: :thumbup: :luck: :thumbup: :laugh:
    Blocking is a great feeling.
    To do it, many times means to put in more time than a regular admission.
    I stuff them regularly, 2-3 times a month.,
     
  30. Leukocyte

    Leukocyte Senior Member
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    ER doc reason for admission: "AMS (Acute change in Mental Status) secondary to constipation" Abd CT-Neg. for obstruction or pathology. Labs-Neg.

    IM intern response: :laugh: Admit :rolleyes: , give fleet enema & lactulose, then discharge in am.


    ER doc reason for admission: "Weakness in Left Upper Extremity secondary to R CVA -LUE Xray-Neg, Head CT-Neg done by ER "doc" prior to admission "

    IM intern reponse: :laugh: Admit :rolleyes:, take a GOOD/PROPER H&P, find out that pt fell on Left elbow, give Tylanol and D/C in am.
     
  31. RuralMedicine

    RuralMedicine Senior Member
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    I may do Med-Peds but I've never been a big fan of whining or whiners. I think we ALL should strive to treat colleagues and patients with compassion and respect. I'm fortunate to be at an institution where most of the residency programs are strong and disciplines usually work well together. Ultimately we need to remember to strive to do no harm and do the right thing for the patient (which often is not the glamorous or the ego stroking choice), and when other physicians shirk this responsibility sometimes we need to step in and do things that are not really "our job". Recently one of our Ortho teams consulted Medicine to clear a 69 YO diabetic with poorly controlled hypertension and poor functional status for ORIF. Obviously this is someone who should have some invasive testing for risk stratification but if they have a positive stress then they should go to cardiac catheterization and then the surgery needs to be delayed by another 6 weeks. I explained all of this to Ortho and reminded them that perioperative beta blockers are always good, maintain Hb > 10 etc. and they opted to go to the OR in spite of me having to write that the pt. was high risk for perioperative cardiac events. I'm really not critical of their decision to go the OR this was a pt. with a hip fracture and they were kind of backed into a corner. They took the pt. to the OR and I received a call around 8pm from our PACU wanting post-op orders (the pt. was on the ortho service however, the ortho resident on call was refusing to write said orders and had hung up on the nurse after tossing out some expletives I wish she had not felt the need to repeat)--oh and by the way the pt. was having chest pain and had a hemoglobin of 7 did I want to do anything about that? Obviously as the medicine resident it's not "my job" to write admission orders on a consult patient (however at the hospital in question consultants are allowed to write orders) and I certainly could have reminded the nurse she really needed to talk to someone from Ortho about their patient and if the residents weren't being helpful she should call the attending (and I admit that was tempting since I wasn't on call and was only in the hospital at 8pm as I had just finished stabilizing an unstable patient our team had inherited at 5pm) but I knew that wasn't in the patient's best interest. So I ordered blood and an EKG and wrote orders to get the patient admitted to telemetry and I changed the active issues on the pt. over to the medicine intern on call. In the morning I emailed our chief resident about the issue who addressed it with Orthopedics. The pt. ended up doing well which is it the important thing to me.

    At the same time I think we have to realize we are all human and we all make mistakes. I think we do both ourselves and our colleagues a disservice when we look the other way at those mistakes. As has been alluded on this thread the ED should not be expected to make the diagnosis however, they should be expected to stabilize the patient (or inform the admitting that they are having trouble stabilizing the patient), and to proceed with an appropriate initial workup. In general our EM physicians are good but on a recent call I was asked to admit a patient with fever and altered mental status, somehow they had neglected to order a Head CT, do an LP, or start antibiotics. Obviously I need to follow the standard of care and start antibiotics (when I learned of the patient they had been in the department for > 6 hours) then get the Head CT (negative) and then do the LP (protein 82 450 WBCs 0RBCs) subsequent cultures were negative and we ended completing 10 days of Vancomycin and Cefotaxime at which point I repeated the LP (the patient really loved me for this) which had no cells and we stopped antibiotics. In spite of obvious deviation from the standard of care this patient also did well she had been on a course of Levaquin for a "URI" prior to presentation so we presumed it was a partially treated meningitis and perhaps that bought her time. Some might argue that it may have been viral (although she had PMN predominance in her CSF) and blood cultures obtained (by mistake according to the ED chart) grew Strep pneumoniae. She was hypotensive when I saw her initially in the ED and she did end up with a central line, arterial line, aggressive volume resuscitation, and norepinephrine drip prior to her CT Scan. However, she never was hypoxic and initial pH was 7.29, by the next morning we were weaning pressors pH was 7.36 and she was telling me about her grandchildren and apologizing for not letting the intern do the LP or central line (fortunately my intern that month was counting the days until he joins the wonderful world of radiology and was not upset to miss out on the procedures since we would not be using fluoroscopic guidance). Although pleased with the outcome I must admit I was somewhat surprised. At discharge this chart was sent back to the EM department for review (as we are encouraged to do in this system) and I received an email from the chair that the elements of inadequate workup and stabilization were discussed with the resident and attending involved. Obviously complaining that the ED didn't stabilize or workup the patient appropriately at the time would have done little more than distract me from the task at hand, a challenge I'm glad I accepted.
     
  32. Annette

    Annette gainfully employed
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    I DARE you to write the above again after working 108 hours in a week (yes, even in the era of 80 work weeks!) I agree that we should try to do the right thing, but when you are so tired that you can't even keep your eyes open, the umpteenth admission/comsult for stupid stuff is gonna break you.
     
  33. kedhegard

    kedhegard Senior Member
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    :laugh: :laugh: :laugh: :laugh: :laugh:
     
  34. RuralMedicine

    RuralMedicine Senior Member
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    Annette,

    I accept the dare! I believe that both of those incidents took place somewhere between hours 70-110 of a week, the ortho issue actually occurred the day before call and the ED patient represented one of I believe 8 ICU admissions and 10 total admissions for the next day. Before someone suggests I report our program for ACGME noncompliance I think I ended up with 80.44 hours/week or something silly on the monthly average (our medicine chair has a little bit of an OCD streak with the work hours) but the 110-70-70-70 frontload can be a bit painful. Our patients don't make the call schedule and they don't deserve anything less than our best care. If your call schedule has pushed you to the point of meltdown and beyond then you need to do something about that. Perhaps more open communication with your resident would be a start. They may not be able to read your mind or have a realistic sense of the other obligations on your time (ie cross-cover could easily make or break a call when I was an intern) and do not realize you need help unless you ask for it. I'll never fault an intern for asking for help; I will consider repeated failure to ask for help an inability to appropriately assess a critical situation and recommend they are not ready to advance to the next year of training.
     
  35. Annette

    Annette gainfully employed
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    Rural Medicine,

    You are right, something should be done. That is why staying quiet about admissions when they become overwhelming isn't such a good idea. I do the best I can for my patients, and I become very upset when I can't provide good, safe care when I am overwhelmed.

    As for casting aspersions on my ability as a resident because I didn't ask for "help," you are assuming that I didn't (I did) and that the senior resident would help (he didn't). I hope your holier-than-thou attitude doesn't impede your communication abilities with your interns to terribly much. But then you can always just mark them down as not being ready to advance.
     
  36. RuralMedicine

    RuralMedicine Senior Member
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    Annette,

    Several Points:

    1.) I never suggested that remaining quiet and just letting problems stack up is the way to go. It is very possible to (without whining) identify problems and address them with people who can change the situation.

    2.) I actually went back to reread your previous posts to see if I had misinterpreted what you said and in retrospect I suppose I took the neutral stance that you hadn't asked for help. I think there tends to be a myth in many programs that you should be able to handle things on your own and I have learned that it's usually the more competent interns that need a little more reigning than the ones who are average. It also can be difficult to sometimes gauge how over your head you are until you're near drowning. As I said in my post my practice is to look at the trend and the interns typical approach not an isolated incident. Again if you're not getting the help you ask for then that is also a situation you need to address, this is probably especially critical if your unsupportive upper level is a PGY2 and will be guiding interns again next year. It may be a little late for this to be relevant in the case of a PGY3 although if your program has a tendency to hire their own grads back as attendings this may be more relevant.

    3.) I'm sure you're trying and I can understand it's frustrating to navigate the system at times but ultimately getting upset but not trying to change things just sets you up to repeat the same process the next day or the next call. You're right it's dangerous and it's unhealthy so take a deep breath and look for a solution.

    Hang in there in less than a month you will be an upper level! I hope you'll accept the challenge to guide your interns. Being a good upper level can be very hard and sometimes not very rewarding but sometimes it's awesome!
     

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