tag:blogger.com,1999:blog-30499448.post502368761500342507..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Dirty LaundrySid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-30499448.post-25119208860704651462007-04-21T20:54:00.000-07:002007-04-21T20:54:00.000-07:00Very interesting post. I think you were meant to r...Very interesting post. I think you were meant to run in to each other in the elevator and I think it is great that you were able to work it out.<BR/><BR/>Obviously though, that instigating surgeon was was feeling threatened by you and underscores your point about competition and egos, etc. What a waste of energy, although I suppose those egos help get you through the grueling residencies.SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-47466141314329042152007-04-19T21:02:00.000-07:002007-04-19T21:02:00.000-07:00The best solution to an ER consult is to go in and...The best solution to an ER consult is to go in and see the patient, lay hands on the patient, put a note on the patient's chart and deem the case nonsurgical, non-GI, non-renal, non-ENT, non-plastics, non-OFMS, non-neuro, non-neurosurgical, non-ortho or non-whatever. Saves a bunch of headaches, not only for the consultants involved, but also us ER guys. As an ER doc, once a surgeon has seen the patient and deem the case nonsurgical, I am armed to tell the medicine folks, "Listen, the surgeon has seen the patient and he doesn't think it's an acute surgical problem." Or the other way around.<BR/><BR/>The reality of things is that ~95+% of the time the ER doc intuitively knows if the problem is surgical or non-surgical, at least for an old coot like me who's been around the block a while anyway. The remaining <5% of the time, the case is iffy in which only time and serial abdominal exam can tell because more often than likely, an imaging study such as a CT scan with PO and IV contrast has already been done. It's that <5% of time that the medical and surgical folks invariably butt heads on as to who will admit primarily. To me, I don't see how it matters as to who admits if both the surgeon and the medicine doc are on the case. Two heads are better than one, right? But it never fails that both will refuse to admit and punt to the other. In situation such as this, I always apply the big umbrella or big circle approach. I draw everyone, all the consultants, under the big umbrella or into the circle, then I walk out and let them pow-wow among themselves.<BR/><BR/>"Dr. Surgeon, I am formally consulting you to see this patient in the ED. By staff bylaws, you have 2 hrs. to respond and see the patient. If you choose not to, I will be forced to report the incidence. To be fair, I have also consulted Dr. Medicine on call to see the patient as well, since you think that this case is more of a medical problem but the medicine doc does not. The two of you can hash it out amongst yourselves as to who will admit primarily. All I know is that I have a sick person who needs to be taken care of on an inpatient basis. If you disagree, you can discharge the patient home yourself. Thank you."<BR/><BR/>"Doctor Internist/GI/Nephrologist/Cardiologist/etc.., remember that patient that I called you on earlier? I have already consulted the surgeon, who will be seeing the patient in the ED. To be fair to him/her, I am also formally consulting you to see the patient in the ED since the surgeon thinks that it's more of a medicine case and you do not. By staff bylaws you have 2 hours...I'll let the two of you pow-wow with each other as to who will admit the patient primarily. If you disagree with my assessment that this patient needs admission, then you can discharge the patient yourself. Thank you."<BR/><BR/>I've done this countless of times over my career and never once had a patient discharged by either consultants. There was this one time when a young, fresh out of residency internist refused to even come to the ED and see the patient after the surgeon laid his hallowed hands on the man and agreed with me that the case was nonsurgical (the gastroenterologist, of course, was only willing to be a consultant on the case). Needless to say, that young internist was dearly reprimanded and eventually had his clinical privileges revoked as we established a pattern of dereliction on his part. The surgeon was kind to admit the patient and consulted another internist as well as gastroenterologist.<BR/><BR/>The majority of times the argument concerns acute pancreatitis and small bowel obstructions. Most of the time the medicine folks will balk on these cases when all the patient really need is bowel rest and NGT decompression if it's an SBO.Charity Dochttps://www.blogger.com/profile/04096425256928751601noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-64017447742191568022007-04-19T16:02:00.000-07:002007-04-19T16:02:00.000-07:00I stumbled onto your blog and must say I love it. ...I stumbled onto your blog and must say I love it. As a vetran OR nurse and been caught in the middle of 'turf wars', I find myself chuckling. Whether it be about the schedule not moving fast enough or Dr. So-and-So needing to bump Dr. What's-his-name, there is nothing (and I mean NOTHING) worse than an Orthopedic surgeon scorn.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-52462573364278182122007-04-19T07:09:00.000-07:002007-04-19T07:09:00.000-07:00so far only having dabbled in private practise i'm...so far only having dabbled in private practise i'm amazed at the politics of it all. i've already been placed in a camp and i'm therefore already unwittingly at war with the other faction. not that i'm at war with them but they are at war with me. in the words of many a beauty pagent contestant, "why can't we all just get along?"Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-72566400435132103572007-04-18T06:39:00.000-07:002007-04-18T06:39:00.000-07:00The wisdom of experience.When we're young and just...The wisdom of experience.<BR/>When we're young and just out of training, it's amazing how we get sucked into things we later regret.<BR/>Many years ago I learned my lesson, having been called about admitting a man who a general surgeon said had a stroke. There wasn't much we could do back then, it was late at night, I said, "Sure, go ahead and admit him to me" and waited until morning to go see.<BR/>Well, it turns out the guy's neurologic problem was severe carpal tunnel syndrome, and the real issue was failing kidneys. But there I am the attending physician.<BR/>So now I don't admit anyone without taking a look at them first; I don't accept them as a patient without taking a look at them first, even if it's 1, 2, 3 in the morning.Greg Phttps://www.blogger.com/profile/18422487877167541900noreply@blogger.com