Need help staying up 30 hours

[SocialistMD]

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Now that must be a joke. Do you sit in your patients rooms watching them for 30 hours looking for subtle changes? This post is the height of melodrama. What happens is most docs only see the patients on the wards during rounds once or twice a day or when called by a nurse. There are many sets of nurses who constantly change shifts. Knowing who needs extra attention? What attention is that? Do you sit at the foot of their bed to give extra attention?

No, but, as a resident, I do round on my patients (especially those in the unit) multiple times a "shift" and I do notice subtle differences in their look and behavior that signal brewing problems. If I rounded once, colleague 1 rounded once and colleague 2 rounded once, those subtle changes could go unnoticed.

You list yourself as an attending; surely you've signed out to your partners and told them which patients will most likely have problems and on whom they should keep a close eye. How are you able to single them out? Solely by lab abnormalities? Doubtful. It is likely due to your seeing them multiple times, noticing changes and recalling prior patients who had the same pattern that led down the path to sickness. To me, clinical medicine is 90% pattern recognition, and if residents don't learn to recognize by sight the slow progression of sepsis or respiratory failure, they won't know who is sick and who isn't until it is possibly too late for an otherwise easy save.

 

[exPCM]

No, but, as a resident, I do round on my patients (especially those in the unit) multiple times a "shift" and I do notice subtle differences in their look and behavior that signal brewing problems. If I rounded once, colleague 1 rounded once and colleague 2 rounded once, those subtle changes could go unnoticed.

You list yourself as an attending; surely you've signed out to your partners and told them which patients will most likely have problems and on whom they should keep a close eye. How are you able to single them out? Solely by lab abnormalities? Doubtful. It is likely due to your seeing them multiple times, noticing changes and recalling prior patients who had the same pattern that led down the path to sickness. To me, clinical medicine is 90% pattern recognition, and if residents don't learn to recognize by sight the slow progression of sepsis or respiratory failure, they won't know who is sick and who isn't until it is possibly too late for an otherwise easy save.

Your dedication to your patients is admirable. However what you describe is not standard of care in the private practice world. Attendings can't leave their offices multiple times per day to round on hospital patients and most hospitalists only have time to round maybe 2x/day.

 

[Winged Scapula]

I think Socialist might be suprised to find that in private practice general surgery most that I observe do not round on their "simple" cases - ie, the lap choles, appys, etc. I wondered early on why I got such a greeting when I came in at 0600 to round on my post-op patients, only to find that the general surgeons never came in (except for ICU patients and even then those were managed by the hospitalist and Critical Care team, and more complicated general surgery patients who again are managed by hospitalist except for wound care) unless the nurses called with a problem.

I was a bit shocked to find out that the nursing staff was "not used" to having surgeons come in and round and consequently a lot of things I ordered didn't get done - all because, as I suspect, they thought I'd never find out.

PP is indeed a whole different world than academic medicine with residents in house 24/7. After seeing what I have, I don't think I could ever do general surgery in PP, at least not the way the locals practice it.

 

[SocialistMD]

I think Socialist might be suprised to find that in private practice general surgery most that I observe do not round on their "simple" cases - ie, the lap choles, appys, etc. I wondered early on why I got such a greeting when I came in at 0600 to round on my post-op patients, only to find that the general surgeons never came in (except for ICU patients and even then those were managed by the hospitalist and Critical Care team, and more complicated general surgery patients who again are managed by hospitalist except for wound care) unless the nurses called with a problem.

I think that is group specific. The surgeons at the community hospitals where I moonlight always write daily notes and, at times, I see them on the floors when I'm leaving at 6am. They also have PAs that take care of the daily floor work. I do understand that in private practice, things are different. Perhaps that is one of the reasons I'll be staying in academics. However, just because it isn't the standard practice doesn't mean it won't be my standard practice.

However what you describe is not standard of care in the private practice world. Attendings can't leave their offices multiple times per day to round on hospital patients and most hospitalists only have time to round maybe 2x/day.

That's correct. However, as I suggested in my initial post, I think they know how to sign out patients because they are better at recognizing patients in trouble due to their training. We know that quarterbacks recognize defensive formations because they spend time looking at films, studying patterns and trends and you wouldn't expect a rookie quarterback to be as good as a veteran at reading defenses (I apologize for the football analogy, but I'm watching the Cowboys game). This is the same sort of deal.

 

[Winged Scapula]

I think that is group specific. The surgeons at the community hospitals where I moonlight always write daily notes and, at times, I see them on the floors when I'm leaving at 6am. They also have PAs that take care of the daily floor work. I do understand that in private practice, things are different. Perhaps that is one of the reasons I'll be staying in academics. However, just because it isn't the standard practice doesn't mean it won't be my standard practice.

I find it a bit disturbing myself and I practice the way I think is right and fits the standard. Plus I like to micromanage (well, I don't like to, but feel the need to). It does depend on the group - I have a couple of friends who do general surgery here in town and I know they round, but several of the older ones (ie, late 40s/50s) do not.

Good for you for realizing what is right, even if it isn't what everyone else does.