Saturday, June 23, 2012

Fun with Consults, Part 2

Why all the residents at Staywell Rehab Hospital hated doing consults:

Me: "Hey, you said you'd staff this consult with me if I finished it before 2:45 and it's 2:30 now. Can you see the consult with me?"

Attending A: "Well, something came up and I'm kind of busy. Can you ask Attendings B and C?"

Me: "Oh. Okay."

Later:

Me: "Hey, do you have time to see a consult with me?"

Attending B: "Did you ask everyone else?"

Me: "Um..."

Attending B: "Well, maybe. If nobody else can do it. But I have to see another patient first. I'll call you when I'm done."

Me: "Call me where? I'm just at a random phone."

Attending B: "Oh, then I'll page you."

Me: "But do you have my pager num--" [phone is dead]

Later:

Me: "Hey, do you have time to see a consult with me?"

Attending C: "No." [hangs up]

Later:

Me: "Nobody will see the consult with me! Are you sure you don't have time?"

Attending A: "I can't. But you should make Attending B or C do it. I'm sure they have nothing to do right now."

Me: [sighs] "Okay."

Later:

Me: "Do you have time to see a consult with me?"

Attending D: "No, I have two admissions. And don't even bother asking Attending E, because she's in a conference. And Attending F left for the day."

Me: "Oh."

Attending D: "What about Attending A? Or Attending C?"

Yes, the above actually happened to me.

I finally went to where Attending B was seeing a patient and camped outside the room until he was done. He saw the consult with me, which took maybe 15 minutes. I think I spent longer paging every rehab attending in the hospital than it took him to see that consult.

I remember there was one evening when it was like 5:30PM and I got a totally non-urgent rehab consult, and the chairman happened to be right next to me and wanted me to see the patient immediately. His exact words were, "In the real world, when someone asks you to see a consult, you have to say YES." I later wished I had recorded his words, so I could play it back in situations like these.

8 comments:

  1. Sounds like a horrible way to structure a consult service. At my school, we have one attending assigned to each consult service, so there's no haggling or arguing about who is going to see consults. Seems much simpler!

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  2. Why did you guys need a staff to consult with you? At our hospitals residents usually see consults first and report back to the attending.

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    1. Yes, I was reporting back. I already had seen the consult and done 90% of the work. I just needed them to pop in the room and say hi. That's why it was so maddening.

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    2. Do the patients you seen on consult not get admitted/followed by the attending afterwards?

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    3. Most consults didn't really get followed, at least not for very long, since the purpose of most consults was, "Can this patient be admitted to rehab, yes or no?" The service the patient went to depended entirely on their injury, not which attending saw them. So for most consults, it was a one shot deal.

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  3. This would be maddening!! I've never been on a consult service that operated that informally, and the only one to be somewhat complicated was neuro (i.e. one staff for emerg unless it was stroke, another for floor consults, and still another covering the other hospital site and maternity).

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  4. dont staff get paid for every consult they see? sounds like it would have been an easy couple of bucks! that is really maddening!

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    Replies
    1. Not at an academic institution, no.

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