Resentment in the hospital

[username456789]

No, no... I can appreciate that social and political analysis take a long time .. and that the definition of "Amateur" goes far beyond "not getting paid for it"

That's an interesting line you push.. Where misguided commentary becomes outright fraud ... you apparently are a "master" at it...

And you DO KNOW it's quite insulting to be talked down to by a mildly intelligent person who has no idea what they are talking about...

But here's another good one, possibly from one of your "Colleagues"...

It's your next question.....
---> What subcategory would you put this in...?


View attachment 223323

Seriously, lithium is like dirt cheap.

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[username456789]

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[Cura_te_ipsum]

When you ask me to do it and then want to call me up to argue about it when you don't like the results, you are really not improving anyone's lives.

At least you dont get beach slapped like a Federal Judge did to this attorney

'Shut up,' judge tells Menendez lawyer

“Shut up for a moment if you don’t mind,” Walls said. “I said what I said” to “underscore what I considered the lack of merits in this motion," Walls added.

Walls said he “didn’t disparage you.”

“Now I feel quasi-insulted. You tell me where I have ever speculated to affect the interest of a defendant before a jury,” Walls said. “I want you to tell me where I have done something that reasonable jurors and lawyers would consider speculative and proactive.”​

 

[HooliganSnail]

Dude, it's a thread about things that breed resentment in the hospital. These are things that breed resentment among fields like gen surg and gen med. I'm not sure why you feel the need to get up on your soapbox in here.

I resent difficult residents who push back about admission because they are lazy, and don't want to do the paperwork, even though their obnoxious behavior is contrary to what is the best for the patient.

 

[michaelrack]

Attending physicians just don't talk like that, and if they do, they change their tone real quick, because they know that patients = revenue.

not necessarily true. It depends on their employment situation, contract, productivity bonus, etc

 

[sliceofbread136]

Is it me or does it seem that all subspecialists get ultra defensive when you question why a patient can't be admitted to their service?

 

[jdh71]

Because managing head bleeds is hardly my area of specialty or interest?

Why not just stick a nonop diverticulitis on NSGY by that logic?

If it makes you feel any better I get *both* the op and non-op head bleeds on *my* service. I also get the ortho, ENT, and urology disasters on my service. These days even the general surgeons dump the vented and or pressor requiring patients on my service. My hospitalist colleagues dump anything the even remotely smells like being hard. I get all of GI and Cardiology's patients now too. Neurology stuff? My service.

The only folks in the building these days still trying to do their own work are the CV surgeons. God bless them. And the Family Practice service (though they do have residents).

I guess I don't mind too much because I do bill for my time and or work and often enough there is something critically ill going on. But I have to admit finding myself annoyed on Friday afternoons and anything that comes in after 2am that should be managed by a more specific service. The guys that chap my ass the most though are the cardiologists who should freaking know better. I understand that the trade off in ortho was the brain for the paycheck and it's s political hospital money battle you can't win anyway so no practical reason to run to the top of that hill and die Custer at Little Bighorn style. I do think I should get paid better for the hand holding and babysitting I do because I'm helping a lot of folks out so they can do what they want. But life isn't fair I guess. The one thing that does make a big difference is when one of these guys actually thanks me. Goes miles. And maybe it's not being appreciated that really breeds the resentment. No one likes to think someone else thinks they are their "bitch".

 

[jdh71]

On a similar note, the psych ward is not a boarding service for your unplaceable patients, even if they do happen to have mental illnesses.

Looking your way, Internal Med...

If you'd fix them so they start taking their meds right for the hundred of chronic illness that aren't being handled by them correct BECAUSE of their mental illness we'd both be avoid them. Yeah?

 

[Wordead]

If you are consulting psychiatry, please note:

1) If your patient is intubated, in the ICU, and nonverbal, I do not have a magic incantation for making them not be agitated. I will see them every day because our policies require us to, but getting snarky with me because I have not been able to identify which of their 15 medical problems is causing them to be a little worked up gets us nowhere. My impression is that neurology, who you also consulted about this, is also not super appreciative of the attitude.

2) You can have it one of two ways: either you can ask us to do your capacity evaluation for you when a patient makes a decision you don't like, or you can do it yourself. When you ask me to do it and then want to call me up to argue about it when you don't like the results, you are really not improving anyone's lives.

Wow, I've called some terrible psych consults before but consulting on an intubated nonverbal patient is another level.

Is it me or does it seem that all subspecialists get ultra defensive when you question why a patient can't be admitted to their service?

For me, it's usually because the person asking the question doesn't seem to understand that if a patient 100% does not need an intervention from us, there is no role for them on the subspecialty service. Our university ED seems to really struggle with this concept.

 

[WingedOx]

If you'd fix them so they start taking their meds right for the hundred of chronic illness that aren't being handled by them correct BECAUSE of their mental illness we'd both be avoid them. Yeah?

We're still working on the perfect med that causes people to be adherent to their other meds. I'm sure when we do, it'll be dosed QID.

Though that does tangentially remind me of a case from residency about the hierarchy issues that do come up. We got a consult for an 18 year old diabetic who kept putting himself into the hospital with DKA due to constant nonadherence. IIRC, the consult from MICU was for capacity to leave AMA, if I remember right we saw him and said he didn't. Later that afternoon, the MICU attending wrote a really awkwardly worded 3 sentence-long progress note that said something like "psych saw patient ok to discharge" which implies something we clearly didn't say. I called up the MICU resident and told her to please have her attending to correct his note.

The next morning, my team is rounding, the the old MICU attending calls us aside to chew me out for how inappropriate it was for someone other than another attending to tell him to correct something (though sarcastically apologizing for the fact that english isn't his first language and said that this was simply the custom where and when he trained in Turkey). I was nearly ready to get back in his face for it but my own attending gave me a look like "it's not worth it." and later said he was a ****head like this all the time.

My idealized attending response to that scenario would be responding "excuse me, but in asking you to correct your error, we're not only protecting our own liability but yours as well, and the proper response to someone providing you with this information regardless of training status is "thank you, sir or ma'am" and if you need the help of our team for one of your patients, I would greatly appreciate if you treated all members of said team with an appropriate amount of professionalism, particularly when intimidating trainees not to report errors because your ego is that large is a serious issue for patient safety, and I don't give a f-ck where or when you trained. It's ~2013 in the state of Illinois and that sh-t is frankly unprofessional and unacceptable," in front of his team of residents and students. I have absolutely no tolerance for that type of behavior if you're working with me on a patient care issue.

[whatchoutwegotabadassoverhere.jpg]

 

[WingedOx]

Wow, I've called some terrible psych consults before but consulting on an intubated nonverbal patient is another level.

.

It's more common than you'd think.

 

[jdh71]

We're still working on the perfect med that causes people to be adherent to their other meds. I'm sure when we do, it'll be dosed QID.

Though that does tangentially remind me of a case from residency about the hierarchy issues that do come up. We got a consult for an 18 year old diabetic who kept putting himself into the hospital with DKA due to constant nonadherence. IIRC, the consult from MICU was for capacity to leave AMA, if I remember right we saw him and said he didn't. Later that afternoon, the MICU attending wrote a really awkwardly worded 3 sentence-long progress note that said something like "psych saw patient ok to discharge" which implies something we clearly didn't say. I called up the MICU resident and told her to please have her attending to correct his note.

The next morning, my team is rounding, the the old MICU attending calls us aside to chew me out for how inappropriate it was for someone other than another attending to tell him to correct something (though sarcastically apologizing for the fact that english isn't his first language and said that this was simply the custom where and when he trained in Turkey). I was nearly ready to get back in his face for it but my own attending gave me a look like "it's not worth it." and later said he was a ****head like this all the time.

Now that I'm the attending myself, my response to that scenario would be responding "excuse me, but in asking you to correct your error, we're not only protecting our own liability but yours as well, and the proper response to someone providing you with this information regardless of training status is "thank you, sir or ma'am" and if you need the help of our team for one of your patients, I would greatly appreciate if you treated all members of said team with an appropriate amount of professionalism, particularly when intimidating trainees not to report errors because your ego is that large is a serious issue for patient safety, and I don't give a f-ck where or when you trained. It's ~2013 in the state of Illinois and that sh-t is frankly unprofessional and unacceptable," in front of his team of residents and students. I have absolutely no tolerance for that type of behavior if you're working with me on a patient care issue.

[whatchoutwegotabadassoverhere.jpg]

Attendings should talk to other attendings though. I think your resident to resident conversation was fine as far as it went and I'm not excusing disrespect. But I can see how the attending felt disrespect when your attending didn't take the time to talk to him directly. I might argue you drew first blood and if you start swinging fists don't be too surprised or indignant if you wind up getting your nose bloodied a little as well. You'd think a bunch of folks who are supposed to understand human behavior the best would understand this?

 

[WingedOx]

Attendings should talk to other attendings though. I think your resident to resident conversation was fine as far as it went and I'm not excusing disrespect. But I can see how the attending felt disrespect when your attending didn't take the time to talk to him directly. I might argue you drew first blood and if you start swinging fists don't be too surprised or indignant if you wind up getting your nose bloodied a little as well. You'd think a bunch of folks who are supposed to understand human behavior the best would understand this?

I'd partially agree, but in that case, he can talk to my attending rather than chewing me out. I'd certainly not call another service's attending directly in that case, but even today I want all members of my team to feel confident speaking up if they see something concerning, particularly an error. If he wants to run his team that way, fine, but don't think about trying to enforce his ego on mine. If he has a problem with a resident informing him of an obvious problem, he has no business in academic medicine.

Plus, it was a STAT consult and our asses needed to be covered before the kid bolted out the door.

 

[jdh71]

I'd partially agree, but in that case, he can talk to my attending rather than chewing me out. I'd certainly not call another service's attending directly in that case, but even today I want all members of my team to feel confident speaking up if they see something concerning, particularly an error. If he wants to run his team that way, fine, but don't think about trying to enforce his ego on mine. If he has a problem with a resident informing him of an obvious problem, he has no business in academic medicine.

Plus, it was a STAT consult and our asses needed to be covered before the kid bolted out the door.

Don't see how your asses weren't "covered".

I see you guys getting into an unnecessary fight. Again not excusing any disrespect you got from the ICU doc in his interaction. But your attending should have had the common decency to talk to him directly if he didn't like the guy's documentation.

 

[clausewitz2]

We're still working on the perfect med that causes people to be adherent to their other meds. I'm sure when we do, it'll be dosed QID.

You're thinking way too small. Adherumab should clearly be a biologic requiring weekly infusions like ketamine. That's how we bring up our numbers on those salary surveys.

 

[clausewitz2]

Don't see how your asses weren't "covered".

Uh, because the documentation stated "oh yeah psych said it was fine for this kid to leave"? This kid does something foolish and someone is in a lawsuit happy mood, psych consultant gets deposed, what do you think the plaintiff's counsel is going to home in on? Then you have the wonderful decision whether you just stick with "the primary team was just lying, we never said that" or explaining why actually it was totally okay that the kid left in the context of something bad having happened as a result.

 

[jdh71]

Uh, because the documentation stated "oh yeah psych said it was fine for this kid to leave"? This kid does something foolish and someone is in a lawsuit happy mood, psych consultant gets deposed, what do you think the plaintiff's counsel is going to home in on? Then you have the wonderful decision whether you just stick with "the primary team was just lying, we never said that" or explaining why actually it was totally okay that the kid left in the context of something bad having happened as a result.

Psych had their own documentation. No?

I can't tell *you* or anyone else what another consultant "says" only the consultant can do that.

The only person whose ass is on the clothesline here is the ICU attending. His documentation. His decision to discharge. In fact he probably really muddied the waters for himself by consulting psych at all. He was cynically trying to cover his own ass (I'm sure). But telling if a patient is competent is pretty easy. It's telling if they are not that can be hard. The best documentation isn't a psych consult in my opinion and I involve these guys as little as possible with my service (I have to get their input on any suicide attempts). Documentation by me and the nurses that the patient is in his right mind in an obvious clinical sense and a discussion that I think it's stupid to leave and increases the risk of DYING is all I do. They sign the paperwork and go. I don't run a prison. Peole have a right to make bad decisions.

 

[clausewitz2]

Psych had their own documentation. No?

I can't tell *you* or anyone else what another consultant "says" only the consultant can do that.

The only person whose ass is on the clothesline here is the ICU attending. His documentation. His decision to discharge. In fact he probably really muddied the waters for himself by consulting psych at all. He was cynically trying to cover his own ass (I'm sure). But telling if a patient is competent is pretty easy. It's telling if they are not that can be hard. The best documentation isn't a psych consult in my opinion and I involve these guys as little as possible with my service (I have to get their input on any suicide attempts). Documentation by me and the nurses that the patient is in his right mind in an obvious clinical sense and a discussion that I think it's stupid to leave and increases the risk of DYING is all I do. They sign the paperwork and go. I don't run a prison. Peole have a right to make bad decisions.

I think you stance on this is not unreasonable so far is it goes, but I also suspect that if a dedicated C&L service thought he did not have capacity, this kid's nonadherence had more to it than "oh I guess I forgot to take my insulin today" or "I really wanted some pie and thought it would go okay." Capacity IS something that most physicians should be able to assess, you're right, but it takes a bit more than "is this person not obviously disturbed?" Without details, though, we are just sort of speculating wildly.

Agreed that if push comes to lawsuit in this sort of situation psychiatry is probably not going to be the target of a lawsuit, but they might still get called as a fact witness in the ensuing suit against the ICU attending/hospital which is still somewhat less than ideal.

 

[sgv]

Because that's like me accepting a patient with ludwigs angina and admitting them to ent
Why should anyone have to clean up someone else's mess?

 

[jhamaican]

only resentment I ever feel is toward fellow residents.

Attendings, other specialties have always been great.



Bro: you want to go into cardiology, are on the cardiology consult service, and are complaining about me giving you a cardiology consult?

You should be happy for the chance to try to impress the cardiology attending.

 

[Crayola227]

being a doctor in so many fields is often 90% "professional idiot management"

no one seems to particularly enjoy the idiocy, even when the job was signing up for dealing with patient idiocy, and even if as an attending you get paid for other doctors' idiocy, I find in general we have less tolerance for one another's idiocy

no one likes the stupid admit or consult, is my point, and I like to think we expect more from one another from a medical management and decision-making standpoint than we do from patients

in fact, they even did a study in game theory, I believe, that as the pay for a seemingly pointless task goes up, satisfaction goes down
chew on that

 

[Broponinelevation]

I will say that is one of the good things about doing your MS3/4 year is getting the perspective of many different specialties. We definitely got a few consults on psych that were just ludicrous....but the same is true when you are on cardiology, GI etc. Same goes for the emergency room docs and calling consults, admissions etc. that they haven't done a full workup for. All that to say is that as people go thru residency/fellowship/years of practice- people definitely become more set in their ways and find it more difficult to understand what life is like for their colleagues of other fields. Definitely did see resentment though- but I also saw resentment of all the residents for various reasons, so it gives a little perspective.