Wednesday, July 6, 2011

Tales from Intern Year: Cross Cover, part 2

This is an email we got during intern year from the (usually very nice) intern currently doing the cross cover rotation, just to prove I wasn't shitting you about the sign outs people would give:

A few things that have been stewing that I wanted to get off my chest beforeI have a meltdown and buy a 12-gauge (and I don't mean a needle) and go medical on all of you. They relate mainly to cross-cover etiquette, issues that at this time of year really shouldn't be happening anymore, but for some reason they still are.

1. Pt location: I understand that the staff sometimes randomly moves patients around, and people in EAU going to floor/TCU don't have bed assignments when you sign them out to me, but some patients don't have their locations updated for days. When you ask me to f/u Pulm rec's, the first thing I do is look for pt location. If the signout sheet says TCU, and I go there only to find the pt has been in 3C (and has been there for the last two days), I will be pissed. Usually I am helpful and update the pt location for you on the signout sheet (that's usually _after_ I go to the wrong ^%&*%^$ place). Sometimes I find I have to do that a few times in a row. If that happens, I will be pissed. Why should I have to second-guess your signout sheet, go to a computer, log in, get on MDwebstation, type in pt's MRN, and find the pt's location while all you had to do was spend a few seconds to be on top of the info on your signout sheet? Why should I have to spend an extra 20sec to 2min to find the exact room by scanning the pt chart rack or pt list when all you had to do was spend 5sec extra to input the pt's actual room number instead of the lazyass "TCU" or "4C"?

2. "F/U GI rec's": I have no problem following up rec's, but in the last few days I have noticed several people signing out to me in the afternoon when the rec's were already in the chart by morning. If you want me to f/u rec's you should make sure they are not already in the chart by the time you sign out. If you are post-call, I will let innumerable things slide, but if you are not post-call you've got no business asking me to do your *&&^()*^ job for you. One of you was so blatant about it that when I opened the chart, I saw the consult note on the left side, and lo and behold, your progress note on the right side, dated after the consult note. I was already talking about this today with a previous x-cover, and just now during this current shift it happened to me again. I swear, if this happens again, I will not hesitate to let the offending parties know the deepest darkest feelings of my heart during signout, regardless of how many other colleagues are sitting around in the room waiting to sign out.

3. Picking up signout sheets in the AM: most people are good about this, but some are not. If you don't want to know what I wrote on the sheet, that's fine, but then I will just stop writing on your sheet in the future.

4. "F/U PM P7": do you REALLY need to check a PM P7? If your patient has no previous electrolyte abnormalities, is not on diuretics, is not on massive doses of IVF, is not vomiting, pooping or peeing more or less than normal, maybe you should reconsider that reflexive "f/u PM P7". I've noticed an order of magnitude increase in "f/u PM P7" since my last x-cover rotation earlier last year, and most of them are either stone cold normal or somebody will have something like an iCa of 1.13. Stop the press! Call RRT! Infuse that Ca gluc STAT! Somebody should get me a razor blade and draw me up a hot bath STAT.

Of course, after that email, we were all terrified to sign out. It was almost funny. I watched my co-intern sign out a PM chem panel for him to check and she quickly added, "I didn't want to order it! My resident made me!"

Then a few days later, I was transfusing my patient who had the hematocrit of 7 and I ordered a post-transfusion CBC. I told the cross cover intern I was ordering it, "But you don't have to follow it up!"

"Are you sure? That's a pretty low crit."

"Uh, I think it'll be okay!"


  1. This email writer is nothing short of awesome.

    I used to live in a sorority, which means I got real used to passive-aggressive "Um, could whoever's leaving crumbs on the counter please consider other people once in awhile? K! LOVE AND KISSES!" notes, the direct honesty here is just amazing to me. I love it.

  2. Yeah, the guy who wrote this was one of my favorite co-interns. And right on the mark about everything.

  3. Wow... I only had to do 2 months of IM in my residency, and I must've lucked out or something, because I can't believe some of this stuff! Interns should not ever do this sort of thing to each other (I mean crappy sign-outs, not the email itself which is awesome)! I can't remember hearing about this sort of thing from other interns either, so maybe the intern cohort was just really conscientious... My team definitely had a lets-get-through-this-together mentality, thank god!

  4. This sounds like an intern who reeealy needs a vacation. While everything he said was presumably true, that's a pretty angry letter to write to your co-workers.