As a resident, you're sometimes forced to call consults that you don't think are necessary. I mean, your attending is sort of your boss, so if they tell you to call a stat GI consult on a patient who obviously has hemorrhoids, what can you do?
This is the most embarrassing consult I was ever forced to call:
I had a patient during residency who was wearing a condom catheter for incontinence. He had a rash on his penis that I thought was very obviously a contact dermatitis from wearing basically a condom all day. However, my attending looked at the rash and thought it was kind of flaky. So he forced me to call dermatology and ask if the patient might have psoriasis (localized to his penis).
I was pretty embarrassed having to call derm and ask if this penis rash was psoriasis. I wanted to ask them, "Is this the stupidest consult you've ever received?"
That is the worst feeling, especially because you know that you;re the one who will be yelled at for their idiocy. You just hope that your staffs reputation will make the other consultants groan with a knowing nod when you tell them why you're calling them.
ReplyDeleteDuring my rehab/aged care term as an intern (Australian internship includes, medical, surgical, ED and random rotations), I had a great consultant and a speshal registrar (ie. someone who is training to be a rehab physician). Unfortunately rehab as a specialty in this part of the world has a high proportion of trainees who have either forgotten or never attained basic medical knowledge and claim that all such things are beyond them.
ReplyDeleteMy great consultant was well aware of this situation, and after a particularly frustrating exchange with my registrar*, he told me a tale of when he was a rehab registrar and was forced by his consultant to get a dermatology consult for a small, round lesion on a patient's wrist, that looked like some sort of puncture wound. Turned out to be a IV cannula site...
* Two weeks after sending off a sputum sample for a patient with a cough, the result came back as Moraxella catarrhalis, sensitive to every antibiotic ever invented. As the patient was better, I filed the report in the B for Boring pile. My registrar came across the report and demanded that I request an infectious diseases consult immediately as "we are rehab doctors, we are not trained to interpret these results". I explained that I was actually a doctor and as such was trained to manage this very situation. And even if the patient had been unwell, I could still confidently manage their care by selecting any of the twelve antibiotics that the bug was sensitive to.
You SHOULD have asked them that. I would have loved to hear their response. I had an attending once who was covering over the weekend call a derm consult on a completely non-emergent problem that was also completely unrelated to the reason the guy was in the hospital. When derm took "too long" to respond (in his opinion) he called the chairman of the department and reamed them out about how lazy their residents were. I was mildly horrified.
ReplyDeletepsst...you wrote "to call GI" not "to call derm." I think it would be an even dumber consult if you had to call GI about a rash on the penis :-)
ReplyDeleteWhoops! Thanks, JessJess :)
ReplyDeleteMy worst consult was phoning neurology about a patient with an abnormal gait - who had just been discovered to have multiple brain mets. The attending wanted to know whether there could be another cause of the abnormal gait. You know, other than the multiple lesions in his brain causing cerebral edema and obstructive hydrocephalus.
ReplyDeleteMy second year, a gal who was about 2 wks postpartum was somehow admitted to medicine. We got consulted for her vaginal discharge. I ended my note with "recommend peri-pads and daily washing. Thanks for the interesting consult. Will sign off."
ReplyDeleteMy attending was amused.
Another time, ICU consulted us for vaginal bleeding. Her husband said that her LMP was about 4 wks earlier. We signed off of that case as well.
I just had to call the least necessary intensivist consult ever. The patient was completely stable, and set to be discharged in the morning, but I discovered his PICC site was leaking. His attending ordered a stat consult to the intensivist; I never did figure out why she thought that was necessary. I questioned the order, and so did my charge nurse, but the doc insisted.
ReplyDeleteFortunately, the ICU call room is just down the hall from us, and the intensivist that night had a sense of humor. He wandered over just long enough to say hello to the patient, write a snarky two-line note, and sign off.
ooh, I have one. I was consulted as a neurology resident for a patient who had been admitted after a trauma of some sort, and they said "we just realized no one's seen him move his legs for a few days." They thought maybe it was transverse myelitis. But he was on his way to the OR, they told me, so could I see him later? Hours later, after he came back from the OR, I went to see him and asked what he had to go to the OR for, anyway? He had to go for bilateral fasciotomies up to the thigh, for his severe compartment syndrome. But they didn't think they would be able to save the legs, they told me, they were probably going to amputate them tomorrow.
ReplyDeleteso.... 1) they called me because he was not moving the legs that he was about to not HAVE anymore. 2) when they called he was already en route to have surgery for the fact that he had infarcted his muscles. His leg muscles. Which they wondered why he wasn't moving.
Stupid consults are always amusing, at least if you manage to look horrified enough to get across the point that you -know- it's useless. But they get even better when you're consulting your own home service while rotating somewhere else, and you know EXACTLY what's wrong and how to handle it, and the consulting doctor knows that you know because he's taught you that two months prior, and you both know that the patient does not have the horrible dreadful disease that is suspected and if he did, it would be currently mismanaged. The conversations tend to include a lot of "I know, sir" from the resident side, a concluding "Deal with it yourself, OK?" from the consulting doc, and a farewell of "I wish they'd let me..."
ReplyDeleteAnd yes, gotta love the unexplained vaginal bleeding q4weeks. Or the "large abdominal tumor on palpation" with "cramps q4min and increasing intensity" that earns a surgical consult.
As a GI fellow, I once got consulted by neurosurg (the NP, not the residents) on a patient with "bright red blood in her underwear." Said patient had multiple mycotic aneurysms, one of which had burst, a fungal vegetation on her mitral valve, and was in renal failure from a combination of her bacteria and infarcting her kidneys (and Nephro felt that she was too sick to dialyze). Her hemoglobin was 14.5. When I was talking to her mother (because the patient herself was comatose) for the consult, the mom mentioned that the patient had started having her period a few days earlier. Signed off on that right quick!
ReplyDeleteYep, last month my OB/GYN resident got consulted by cards in the middle of the night for vaginal bleeding. In a reproductive-aged woman whose LMP was four weeks before. She was PISSED.
ReplyDelete