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This is a story that happened to me today that made me a little uneasy, so bear with me since this might get a little lengthy.
Please bear in mind that Im currently doing an internal medicine prelim year and will be entering ophthalmology training in 2008. Its been literally 2 weeks into my internship and this is the first ophthalmology consult I called this year.
We had just admitted a 40s yr old HIV+ female in the AM with asthma for SOB but she was complaining of some swelling and pain in her left eye. During our lengthy attending rounds from 9pm to 12am we discussed the possibility of preseptal vs orbital cellulitis in this women and decided to hold off the consult until we have a CT scan of the orbit available which was scheduled for later in the afternoon. All housestaff was required to attend a noon conference (which they actually keep track of us by making us sign in) and after the conference was over at 1pm my resident comes up to me and says that the attending paged him and asked him to call the ophthalmology consult because he was more concerned about this eye swelling to be an orbital cellulitis.
So at 1pm trying to be a good intern and remembering what tidbits of ophtho I can remember from medicalschool I tried to get all the necessary info including pupil reflexes, extraocular movements, conjunctiva, etc unfortunately I didnt have a Snellen chart with me and remembering one of my old ophthalmology tips from a resident I asked the patient to read off a newspaper print at arms length using one eye then the other.
So now the time is 1:20pm and I think Im ready to call the consult. I page the person on call for consult wait for theme to call back and I let them know that I have a consult for them, identify myself and starting to spew off the pt name, MR number and the location of the patient .
Then the rest of the conversation went like this
Oph res: (in an angry/very frustrated tone of voice) Do YOU have ANY idea what TIME it is?
Me: err 1:24pm?
Oph res: (same tone of voice it doesnt change for the rest of the conversation) Well you should know that you should call your consults EARLIER. I have a FULL clinic down here and itll take AT LEAST an HOUR to see the patient.
Me: Well, my resident just asked me to call the consult and we just got the patient this (I get cut off here)
Oph res: Well TELL me about the patient.
Me: Well this is a 45F with HIV who came in this AM with asthma exacerbation but also complaining that she started having eye pain and the team is concerned about orbital cellulitis.
Oph res: WELL is this AN EMERGENCY?
Me: Errr, I dont know. We are concerned that it may be an emergency
Oph res: Whats her visual acuity?
Me: I didnt have a Snellen chart, but she was able to read a fine newsprint without problems with R as well as her L eye, although she is complaining of some blurry vision in her Left eye.
Oph res: You should really have the visual acuity of the patient before you call the consult. If you dont have a chart you should have asked around your team to get it from SOMEONE. (additional 5 minutes of angry rant about importance of VA goes here, I wasnt quite paying attention) Then she asks for the rest of the information..
Me: (I provide the rest of the information including EOM, Pupil reactivity and description of her affected eye.)
Oph res: (asks the same question in different way)
Me: (I provide same answer)
Oph res: (Goes on another 5 minutes about importance of VA and how to properly call an ophtho consult)
Me: (occasion yes and reassurance)
Oph res: Well you have to bring her down RIGHT NOW in an WHEEL chair to the clinic and you said youre an INTERN right? Call a proper ophthalmology consult next time.
Me: sure thing. (hangs up the phone)
So after all this, I speak to my resident about the consult and he says Yeah, ophtho residents hate medicine residents.
When I heard that I felt a bad for the medicine residents, but I felt worse for our ophthalmology community. In your opinion do you think this is any way to treat another colleague? It was my fault for not having the perfect visual acuity but I think its unprofessional that she yelled at me for calling a consult at 1pm to ruin her clock out time at 5pm. I realize that many of us enter ophthalmology because it gives us the ability to balance the rest of our lives with medicine, but I felt very let down by a future colleague I spoke to today.
I just wanted to share that with you guys and wanted to know what everyones thoughts are regarding my own actions as well as the reactions of the oph resident.
Please bear in mind that Im currently doing an internal medicine prelim year and will be entering ophthalmology training in 2008. Its been literally 2 weeks into my internship and this is the first ophthalmology consult I called this year.
We had just admitted a 40s yr old HIV+ female in the AM with asthma for SOB but she was complaining of some swelling and pain in her left eye. During our lengthy attending rounds from 9pm to 12am we discussed the possibility of preseptal vs orbital cellulitis in this women and decided to hold off the consult until we have a CT scan of the orbit available which was scheduled for later in the afternoon. All housestaff was required to attend a noon conference (which they actually keep track of us by making us sign in) and after the conference was over at 1pm my resident comes up to me and says that the attending paged him and asked him to call the ophthalmology consult because he was more concerned about this eye swelling to be an orbital cellulitis.
So at 1pm trying to be a good intern and remembering what tidbits of ophtho I can remember from medicalschool I tried to get all the necessary info including pupil reflexes, extraocular movements, conjunctiva, etc unfortunately I didnt have a Snellen chart with me and remembering one of my old ophthalmology tips from a resident I asked the patient to read off a newspaper print at arms length using one eye then the other.
So now the time is 1:20pm and I think Im ready to call the consult. I page the person on call for consult wait for theme to call back and I let them know that I have a consult for them, identify myself and starting to spew off the pt name, MR number and the location of the patient .
Then the rest of the conversation went like this
Oph res: (in an angry/very frustrated tone of voice) Do YOU have ANY idea what TIME it is?
Me: err 1:24pm?
Oph res: (same tone of voice it doesnt change for the rest of the conversation) Well you should know that you should call your consults EARLIER. I have a FULL clinic down here and itll take AT LEAST an HOUR to see the patient.
Me: Well, my resident just asked me to call the consult and we just got the patient this (I get cut off here)
Oph res: Well TELL me about the patient.
Me: Well this is a 45F with HIV who came in this AM with asthma exacerbation but also complaining that she started having eye pain and the team is concerned about orbital cellulitis.
Oph res: WELL is this AN EMERGENCY?
Me: Errr, I dont know. We are concerned that it may be an emergency
Oph res: Whats her visual acuity?
Me: I didnt have a Snellen chart, but she was able to read a fine newsprint without problems with R as well as her L eye, although she is complaining of some blurry vision in her Left eye.
Oph res: You should really have the visual acuity of the patient before you call the consult. If you dont have a chart you should have asked around your team to get it from SOMEONE. (additional 5 minutes of angry rant about importance of VA goes here, I wasnt quite paying attention) Then she asks for the rest of the information..
Me: (I provide the rest of the information including EOM, Pupil reactivity and description of her affected eye.)
Oph res: (asks the same question in different way)
Me: (I provide same answer)
Oph res: (Goes on another 5 minutes about importance of VA and how to properly call an ophtho consult)
Me: (occasion yes and reassurance)
Oph res: Well you have to bring her down RIGHT NOW in an WHEEL chair to the clinic and you said youre an INTERN right? Call a proper ophthalmology consult next time.
Me: sure thing. (hangs up the phone)
So after all this, I speak to my resident about the consult and he says Yeah, ophtho residents hate medicine residents.
When I heard that I felt a bad for the medicine residents, but I felt worse for our ophthalmology community. In your opinion do you think this is any way to treat another colleague? It was my fault for not having the perfect visual acuity but I think its unprofessional that she yelled at me for calling a consult at 1pm to ruin her clock out time at 5pm. I realize that many of us enter ophthalmology because it gives us the ability to balance the rest of our lives with medicine, but I felt very let down by a future colleague I spoke to today.
I just wanted to share that with you guys and wanted to know what everyones thoughts are regarding my own actions as well as the reactions of the oph resident.