Surgical consult from Medicine

[Hamilton Bailey]

---

Members do not see this ad.

A sick patient is referred from the medical team for a surgical consult. The on-call surgery intern sees the patient and informs the attending. The surgery attending refuses to "take" the consult and refuses to "take" the patient. (The surgeon is apparently peeved because the IM attending sends all the "operable" patients to someone else, and only "sick" patients to him!) The intern then informs the senior surgery resident abt the patient and asks the next days surgery team to "take over" the patient. The next days surgery team refuses! The intern then informs the IM attending abt how no surgery attending is wiling to "take" the patient. Gets blasted by the IM attending! The poor intern is post call and doesn't know what to do...

What do u suggest the surgery intern could have done to make the situation better?

 

[filter07]

Tell the attendings to talk to each other directly. The intern should not have to relay BS back and forth when there are personal/political battles.

 

[LovelyRita]

A sick patient is referred from the medical team for a surgical consult. The on-call surgery intern sees the patient and informs the attending. The surgery attending refuses to "take" the consult and refuses to "take" the patient. (The surgeon is apparently peeved because the IM attending sends all the "operable" patients to someone else, and only "sick" patients to him!) The intern then informs the senior surgery resident abt the patient and asks the next days surgery team to "take over" the patient. The next days surgery team refuses! The intern then informs the IM attending abt how no surgery attending is wiling to "take" the patient. Gets blasted by the IM attending! The poor intern is post call and doesn't know what to do...

What do u suggest the surgery intern could have done to make the situation better?

Not a thing. Residents and interns are tools, we are there to be warm bodies and see the patients and hopefully learn something. It is a way-too-common occurance for us to get thrown into the middle of attendings' political BS. Just do the best you can for the patient and document everything. (For when the ultimate bummer of being named in a lawsuit occurs.)

 

[Blade28]

Document everything. Talk to your senior resident or chief.

 

[Winged Scapula]

Unfortunately, sometimes you get caught in the middle of these pissing matches (BTW, the scenario you discuss...grudge because of referral patterns is *extremely* common. I was talking with an anesthesiologist last week who was mad at an Ob-Gyn who never used his group for scheduled, day-time cases, but always seemed to call for after hours, emergency stuff. As he was saying, "if I'm not good enough for her private, daytime patients, then I'm not good enough for her emergencies. She can go &^*& herself.").

</off topic>

The intern needed to bump this up to the senior resident, which he/she did and then the senior or Chief resident needed to handle the situation. You/your friend were hung out to dry and paid the price.

As Blade notes, you document document document and bump stuff up to your seniors so that when things go wrong, you aren't the only one in the loop. When that kind of crap happened to me, I was always comfortable saying, "you can call Attending X and discuss it with him if you would like, his pager number is xxxx."

Bottom line: its not your role to moderate arguments between staff, but sometimes you get stuck in the middle. Follow the above rules and you'll get through.

Most importantly: when you are a senior resident, remember this moment and always stick up for your interns and help "save" them in these situations.

 

[Blade28]

Most importantly: when you are a senior resident, remember this moment and always stick up for your interns and help "save" them in these situations.

Agreed.

Get your senior resident or chief involved when things are above your head and you need help (applies not just in this case but in general). If there's a political battle between attendings, and you feel powerless, get some help. And document everything.

What you DON'T want to happen is that your name is the only one on the chart saying that Surgery is "refusing" to take this consult...later on when the litigation lawyers go through the chart you'll be the sole target.

 

[Hamilton Bailey]

Most importantly: when you are a senior resident, remember this moment and always stick up for your interns and help "save" them in these situations.

👍

 

[dynx]

Gets blasted by the IM attending! The poor intern is post call and doesn't know what to do...

Doesn't know what to do? He allready did it. Give a big smile, tell the IM attending "Yep! He said he wasn't taking the case, feel free to page him, thanks Bye!" You will notice quickly, if you can muster the balls just one time, that no one yells (except a few really scary surgery attendings) while you look them directly in the eye and smile.

 

[ESU_MD]

Always take care of the patient when you are a resident

these little riffs are common.

Tell your senior.

A good senior will call the medicine guy
and give him hell for yelling at the intern.

Then tell the medicine guy that if he was so worried about his patient, he should call a surgery attending directly instead of the cowardly way of just writing for a consult and hoping someone magically appears

In my experience, the more of a dump or bogus consult, the less likely the fleas are going to call someone directly. rather, will have the unit clerk call the consult and hope someone "takes over"

sad but true.

Be that as it may- I always make a point of calling a consultant when I place a consult. ESPECIALLY if it is a dump or a babysitting job. its just common courtesy, and doesnt take a long time to do.

 

[DrDawg]

Wow things sound a little different where you are. Here we can't refuse a consult. We can be consulted and refuse to do anything, but that has to be put in the chart. It would be extremely rare for medicine to consult us, and then expect us take over care unless we had plans for the OR.

Agree with the above. If another attending starts in on me, I stop them, and direct them up the food chain.