Tuesday, February 25, 2014

Dr. Orthochick: Trauma patient

The trauma resident paged me around 4AM on Sunday morning and said "there's a pelvis fracture in the ER, Dr. Tenens*** said he's not going admit her and you have to."

OK then.

I went down to the trauma unit to talk to the resident and asked what the heck that was about. He said that the pelvis fracture had been transferred from an outside hospital and Dr. Tenens was really pissed that they assumed he was going to admit, so he decided he wanted nothing to do with it and he wanted ortho to admit her.

See, I have no problem with admitting a pelvis fracture if it's an isolated injury and I'm not worried the patient is bleeding out anywhere. My issue was, Dr. Tenens was pissed about someone forcing him to do an admission so he decided to, uh, force me to do an admission.

I walked down to the ER to see the patient and I examined her and decided she just had an isolated pelvis injury, it wasn't open, she wasn't bleeding, but she was going to need surgery. That being said, I still didn't think it was fair that Dr. Tenens was being a jerk about all this so I paged him and he called me back.

Me: Hi, it's orthochick
Dr. Tenens: [yelling into the phone and by extension, my ear] Are you seeing that pelvis? You better admit her. It's the only injury and it's absolute bulls*** that they expect me to use precious ICU beds when we're short enough! I don't know why they can't talk about this with ortho and just have you guys admit! Do you know what a waste of my time all this was?

And at that point, I made the mature adult decision that this wasn't worth a fight and I should just start filling out my admission paperwork. I was actually sort of proud of myself for that one.

Me: OK, sounds good. I just wanted to make sure we're on the same page about it.
Dr. Tenens: [pause] Oh. So you'll admit?
Me: Yup. She has an isolated pelvis fracture.
Dr. Tenens: Oh. So...you don't need help with anything?
Me: She has no significant medical or surgical history and she is presenting with an isolated fracture with hemodynamic stability. I'm fine.
Dr. Tenens: Oh. So you can handle everything? Do you want us to stay on as consultants?
Me: I can definitely handle everything from here myself. Thanks!
Dr. Tenens: Well...thanks.
Me: See ya later
Dr. Tenens: Do you want me to admit her and then transfer her to your service later after a thorough workup?
Me: Nah, you don't have to do that. She doesn't need any more of a workup.
Dr. Tenens: Well, thanks, Orthochick. Let me know if you need help with anything. Anything.

I guess you really do get more with honey than you do with vinegar. After all that, I probably should have made him admit.

(Also, I must really have a well-deserved reputation as a firecracker if Dr. Tenens was so surprised that I didn't put up a fight. I can only hope this means I'm getting better at picking my battles)

I think Dr. Tenens felt bad about yelling at me because I was walking through the trauma unit a little later and he stopped me and said he wanted to show me a CT scan he thought I would appreciate. Pretty sure that's the attending way of apologizing, because I can't think of why else he would show me a CT scan of a skull fracture. But OK, it was a cool CT scan, we started talking and eventually decided to work on a research project, and really, it's probably a good thing I didn't fight this one.

***The trauma attending


  1. Dr. Tenens felt disrespected because he was *told* to do something rather than *asked*. He probably wasn't opposed to the admission at all, or to doing the work, just the perceived disrespect. Not that he was right to behave that way or anything, but a lot of people behave like that when they feel disrespected. And you're right, you DO catch more flies with honey than with vinegar. It's a shame in a way that hospital culture tends to be more "do it or else because I said so," than, "can you help me out with this one (even if they really mean do it or else)."

  2. Well played. You DO know not to get into a pissing match with a skunk!

  3. My favorite line is "Pretty sure [showing CT] is the attending way of apologizing."

    1. Me too! It made me laugh. So true.

    2. It's a time honored way to apologize. I had an MD that used to shoot off at the mouth when he got stressed... then he'd show me some wicked cool MRI findings or a really crazy skin infection (which he knew was my favorite). Totally an apology. Totally accepted.

  4. Well, at least part of the lesson here is never to accept directs from the periphery.

  5. All I could think of was how sorry I was for you. People find ways to be nasty just to get out of work.

  6. So the outside hospital transferred the patient and just "assumed" your facility would admit? They didn't call ahead of time and speak to an admitting physican?

    That sounds like a pretty clear EMTALA violation. It's not an appropriate transfer unless the receiving facility has been contacted and has agreed to accept.

    Assuming somebody reports it, that outside hospital is gonna be in a world of hurt.