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I/NF CASE #10
** This case is very loosely based on a real story. But its essentially about what happens when an intern is unfairly caught in the middle of a fight between two attendings.
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Links to previous cases:
Case 1 Case 2 Case 3
Case 4 Case 5 Case 6
Case 7 Case 8 Case 9
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A 69-year old black male is admitted overnight for rule-out MI. The afternoon following admission, he undergoes a nuclear stress test which is essentially unremarkable. You are the intern following the patient, and the attending hospitalist instructs you to prepare him for discharge.
When you meet with the family to inform them of the plan, the daughter of the patient immediately becomes irate with you, screaming and yelling that her father “passed out” just before you came in the room. She is adamant that he needs to stay in the hospital for “more tests.”
After unsuccessfully trying to calm the family down, you extricate yourself from the room to call the attending hospitalist (part of the private hospitalist service who covers resident patients only in emergencies), one Dr. Khan. You inform Dr. Khan of the family’s concerns:
“They’re a bunch of psychopaths,” Khan says. “I tried talking to them earlier. They called me a towel head, so I just left the room.”
Silence on the phone.
“Whatever,” Khan continues. “Put in the discharge and send them on their way.” **CLICK**
You feel a headache starting to come on hard, and ask the nurse for an ibuprofen as you open the EMR to put in the orders. Just as you are doing so, you receive a call on your house phone from Dr. Yung, the patient’s long-time cardiologist (who is also a faculty physician at your institution and the program director of the cardiology fellowship you are interested in). The cardiologist instructs you to keep the patient overnight again, using the patient’s syncopal episode as a reason to keep him in the hospital.
Feeling a small measure of relief that you can give the family what they want, and hopefully delay dealing with them again for another 24 hours, you call Dr. Khan again. You inform him what the cardiologist said, expecting him to go along with the recommendation. Instead, the irritation in his voice becomes plain:
“I don’t care what Yung says,” Khan growls. “I’m the attending, and I said to discharge the patient. So ****ing discharge them.” **CLICK**
Feeling a wave of helplessness wash over you, you receive a call from the cardiology fellow who is working with Dr. Yung. She informs you that she just spoke to the family, and that you need to keep her overnight. You tell the fellow that your attending is adamant about discharge.
“Well I agree it’s bull****,” the fellow says. “He can easily go home. But Yung has been seeing the patient for 20 years now, and he knows how the family is. Why don’t you have your attending call him?”
You get off the phone with the fellow, and instead of calling your own attending (who was pissed the last time you called him), you decide to call Dr. Anderson to make the request directly.
“Yes Dr. Yung, this is Jack Stroganoff, the intern,” you say. “We just spoke earlier about that patient in 1214? Yeah... um... I was wondering… uh… if you wouldn’t mind calling Dr. Khan about that whole thing. He was not very happy with me the last time I—”
“No,” Yung says. “Call your own ****ing attending.” **CLICK**
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What do you do?
** This case is very loosely based on a real story. But its essentially about what happens when an intern is unfairly caught in the middle of a fight between two attendings.
====================================================================
Links to previous cases:
Case 1 Case 2 Case 3
Case 4 Case 5 Case 6
Case 7 Case 8 Case 9
====================================================================
A 69-year old black male is admitted overnight for rule-out MI. The afternoon following admission, he undergoes a nuclear stress test which is essentially unremarkable. You are the intern following the patient, and the attending hospitalist instructs you to prepare him for discharge.
When you meet with the family to inform them of the plan, the daughter of the patient immediately becomes irate with you, screaming and yelling that her father “passed out” just before you came in the room. She is adamant that he needs to stay in the hospital for “more tests.”
After unsuccessfully trying to calm the family down, you extricate yourself from the room to call the attending hospitalist (part of the private hospitalist service who covers resident patients only in emergencies), one Dr. Khan. You inform Dr. Khan of the family’s concerns:
“They’re a bunch of psychopaths,” Khan says. “I tried talking to them earlier. They called me a towel head, so I just left the room.”
Silence on the phone.
“Whatever,” Khan continues. “Put in the discharge and send them on their way.” **CLICK**
You feel a headache starting to come on hard, and ask the nurse for an ibuprofen as you open the EMR to put in the orders. Just as you are doing so, you receive a call on your house phone from Dr. Yung, the patient’s long-time cardiologist (who is also a faculty physician at your institution and the program director of the cardiology fellowship you are interested in). The cardiologist instructs you to keep the patient overnight again, using the patient’s syncopal episode as a reason to keep him in the hospital.
Feeling a small measure of relief that you can give the family what they want, and hopefully delay dealing with them again for another 24 hours, you call Dr. Khan again. You inform him what the cardiologist said, expecting him to go along with the recommendation. Instead, the irritation in his voice becomes plain:
“I don’t care what Yung says,” Khan growls. “I’m the attending, and I said to discharge the patient. So ****ing discharge them.” **CLICK**
Feeling a wave of helplessness wash over you, you receive a call from the cardiology fellow who is working with Dr. Yung. She informs you that she just spoke to the family, and that you need to keep her overnight. You tell the fellow that your attending is adamant about discharge.
“Well I agree it’s bull****,” the fellow says. “He can easily go home. But Yung has been seeing the patient for 20 years now, and he knows how the family is. Why don’t you have your attending call him?”
You get off the phone with the fellow, and instead of calling your own attending (who was pissed the last time you called him), you decide to call Dr. Anderson to make the request directly.
“Yes Dr. Yung, this is Jack Stroganoff, the intern,” you say. “We just spoke earlier about that patient in 1214? Yeah... um... I was wondering… uh… if you wouldn’t mind calling Dr. Khan about that whole thing. He was not very happy with me the last time I—”
“No,” Yung says. “Call your own ****ing attending.” **CLICK**
====================================================================
What do you do?
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