When is enough enough?

[SpoiledMilk]

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[FalconSlice]

Any neurologist worth their salt should be able to do a simple LP. Exceptions usually are severe degenerative spine/vertebrae, multiple bone spurs, etc. If the lidocaine is wearing off, the call to IR is much overdue--but they probably didn't want to acquiesce for pride's sake (or probably had been shamed and berated by senior attendings for their incapability). As a medical student, when should you speak up? If you're asking that question, you should, but probably not right in front of the patient. When it was clear that the patient was actually suffering, one could tell one of the residents "I need to speak to you quickly in private." Then express your concerns and offer solutions (i.e., "he's in pain let's either give him more lidocaine or call IR? I just feel uncomfortable with what we're doing to him"). Of course, the trick is not to psych yourself out because "if I say something and piss them off, I won't get honors" which is, unfortunately, what many med students would do since they are victims of terrible assessment/feedback pressure.

 

[Giovanotto]

Any neurologist worth their salt should be able to do a simple LP. Exceptions usually are severe degenerative spine/vertebrae, multiple bone spurs, etc. If the lidocaine is wearing off, the call to IR is much overdue--but they probably didn't want to acquiesce for pride's sake (or probably had been shamed and berated by senior attendings for their incapability). As a medical student, when should you speak up? If you're asking that question, you should, but probably not right in front of the patient. When it was clear that the patient was actually suffering, one could tell one of the residents "I need to speak to you quickly in private." Then express your concerns and offer solutions (i.e., "he's in pain let's either give him more lidocaine or call IR? I just feel uncomfortable with what we're doing to him"). Of course, the trick is not to psych yourself out because "if I say something and piss them off, I won't get honors" which is, unfortunately, what many med students would do since they are victims of terrible assessment/feedback pressure.

What's so hard about saying, "How long does lido usually last, is it possible it's wearing off?"
No harm done, no hurt feelings, everyone wins.

 

[LunaOri]

The general rule-of-thumb for blood draws is "You miss twice, you call someone with more experience". I'd say the same goes for LPs. There is no shame in bumping from resident-->fellow-->IR, when the resident and the fellow have each had 1 or 2 unsuccessful attempts. The failure in this case wasn't being unable to do the procedure, it was not reading the chart and considering the previous history--IR could have been involved from the beginning, because of the previous surgical history of spinal fusion.

(I might consider deleting this thread, because of the medicolegal implications).

 

[GoSpursGo]

This thread has been edited and closed at the request of the OP given the concerns raised in the prior post.