1stYearGunner

2+ Year Member
Oct 17, 2015
28
1
Status
Medical Student
I am an M4 in interview season. One of the practice questions I was asked was the following:

You are on call and a patient needs a lumbar puncture. You have never done one on a patient. But you have practiced on simulation models and have seen attendings do LPs.

The physician on call at home asks you to do the LP. Do you do it?

Is this a skill interns should be able to do without direct supervision?
 

Chemist0157

10+ Year Member
Aug 1, 2007
7,334
571
Status
Attending Physician
1. Don't do it. Find help, or it will wait until help is available.
2. No. Maybe there are some wild wild west programs, but for the most part, hospitals and physicians do not like being sued.
 
  • Like
Reactions: 1stYearGunner

gutonc

No Meat, No Treat
Staff member
Administrator
10+ Year Member
Mar 6, 2005
18,609
11,750
Status
Attending Physician
Ah hellz nah!

The correct answer for those reading along at home is:

"Can you cite the data that an urgent LP, in the middle of the night, by an unsupervised intern that has never done an LP, will change this patient's treatment and not put the patient at risk for complications?"

Would you get raked over the coals in the morning for treating this patient for presumed meningitis without an LP? Probably. But the patient would be unlikely to be significantly harmed, assuming you remembered to ask about drug allergies.

Would you get hung out to dry if you did the LP unsupervised and there was a complication resulting in patient harm and a subsequent lawsuit? Absof***inglutely.
 
About the Ads

rokshana

Member
15+ Year Member
Sep 20, 2004
4,259
4,186
Status
Attending Physician
I am an M4 in interview season. One of the practice questions I was asked was the following:

You are on call and a patient needs a lumbar puncture. You have never done one on a patient. But you have practiced on simulation models and have seen attendings do LPs.

The physician on call at home asks you to do the LP. Do you do it?

Is this a skill interns should be able to do without direct supervision?
No...as an intern you are not alone overnight...call your senior to either supervise you or do it.

In fact, you should not be the one to call the attending on call...that’s your senior’s job.

If, for some reason, your senior is not cleared for LPs, then there is generally a neurology resident or someone in the ED that can do it.
 
  • Like
Reactions: 1stYearGunner
OP
1

1stYearGunner

2+ Year Member
Oct 17, 2015
28
1
Status
Medical Student
Thanks everyone. I stumbled upon another interview question : You are on the code team and you see the senior resident slip a bottle of fentanyl in his pocket. What do you do?

Do we have to talk to the resident, explain him the reasons why. Or is this enough evidence to suspect drug diversion and call the anti-drug diversion team of the hospital?
 
OP
1

1stYearGunner

2+ Year Member
Oct 17, 2015
28
1
Status
Medical Student
I have never worked on a "code team" and I also have had no training on this subject matter in my med school. Is this behavior blatantly outside the regulations? Could the resident not have put it for the purpose of using it for the patient in the room close to the bedside for example?

I know that suspicious activity should be reported to the committee on call at the hospital (Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention). But is this suspicious activity or is it jumping to conclusions?

@psychapp121
 

wholeheartedly

Staff member
Administrator
10+ Year Member
Aug 8, 2009
5,532
3,566
Beyond the Wall
I have never worked on a "code team" and I also have had no training on this subject matter in my med school. Is this behavior blatantly outside the regulations? Could the resident not have put it for the purpose of using it for the patient in the room close to the bedside for example?

I know that suspicious activity should be reported to the committee on call at the hospital (Diversion of Drugs Within Health Care Facilities, a Multiple-Victim Crime: Patterns of Diversion, Scope, Consequences, Detection, and Prevention). But is this suspicious activity or is it jumping to conclusions?

@psychapp121

Lets put it this way, my hospital has a chain of custody for fentanyl and similar meds. If it changes hands/locations it's being documented. It requires two people to sign off on any before leftovers get put in waste disposal system. Pocketing would be a sign of drug diversion.
 
  • Like
Reactions: 1stYearGunner

Vandalia

5+ Year Member
Feb 21, 2014
586
836
Status
Attending Physician
Answers and some general advice:

1. The answer to the question would depend on the supervision policy for the institution. I would be almost certain that the first LP must be done with supervision. Here is the general advice: The correct answer in any testing situation - all the way up to the oral exams for board certification - is the "textbook - by the book" answer. This is never the setting to display the originality of your thought.

2. In any situation such as the fentanyl example, the correct answer is to follow the chain of command and/or get the advice of an experienced attending. As a med student I often heard attendings say, "I will handle it, that is why they pay me the big bucks", and I later used the same line with students/residents. In any unusual situation, never act on your own until you have your own practice with board certification. Even then, always "load the boat" with any advice you can get - and document. General advice: As soon as you land in a new environment, starting with residency, look around and find someone who is well respected, trustworthy, and hopefully wise who you can go to with delicate situations. Even when I held that role for many physicians, I still had my list of people who I could trust. Start looking for that person the first day you start residency and keep doing it for the rest of your career.
 

psychapp121

Account on Hold
Account on Hold
Sep 14, 2018
193
139
Answers and some general advice:

1. The answer to the question would depend on the supervision policy for the institution. I would be almost certain that the first LP must be done with supervision. Here is the general advice: The correct answer in any testing situation - all the way up to the oral exams for board certification - is the "textbook - by the book" answer. This is never the setting to display the originality of your thought.

2. In any situation such as the fentanyl example, the correct answer is to follow the chain of command and/or get the advice of an experienced attending. As a med student I often heard attendings say, "I will handle it, that is why they pay me the big bucks", and I later used the same line with students/residents. In any unusual situation, never act on your own until you have your own practice with board certification. Even then, always "load the boat" with any advice you can get - and document. General advice: As soon as you land in a new environment, starting with residency, look around and find someone who is well respected, trustworthy, and hopefully wise who you can go to with delicate situations. Even when I held that role for many physicians, I still had my list of people who I could trust. Start looking for that person the first day you start residency and keep doing it for the rest of your career.
this. Always ask for help in all situations..it’s better to be asked later why you did something and say “my attending and chair told me to do this” versus “oh I thought this would be the right move and I didn’t tell anyone about it”
 
About the Ads