One thing that really irritates me is when the attending covering a service for the weekend changes all the meds. I'm of the philosophy that weekends are just for emergencies and it's arrogant to think that you are better at managing a patient you just met than the primary team, who knows the patient very well. So I think orders should only be written when absolutely necessary.
But some of the attendings I rounded with during residency seemed to look at the weekends as an opportunity to fix all the patients' problems. I remember one attending Dr. McGill was particularly bad about it. She would flip through all the charts, saying things like, "Why is this patient on so many medications? She shouldn't be on this many medications!" Then we'd decide on a Sunday morning if the patient really needed that second dose of Colace.
Seriously, on Sunday morning I don't think it's appropriate to start changing all of the medications of a patient I just met. If that makes me a bad doctor, then so be it.
But situations like these were the most annoying of all:
Dr. McGill: "Why is this patient [that you never met before] on Zosyn?"
Me: "Uh... well..." [checks sign-out sheet] "He has MRSA pneumonia..."
Dr. McGill: "Yes, but he's already on Vancomycin."
Me: "I guess the Zosyn is to double cover."
But my hypothesizing wasn't good enough. Nor was the fact that the primary attending Dr. Brown's note from yesterday said "Vanco/Zosyn for MRSA pneumonia" and the signout said something similar.
So after discussing this for several minutes, Dr. McGill said, "Call Dr. Brown at home and ask him why the patient is on Zosyn." (She had his number in her PDA.)
Me: "You... you want me to call him at home on a Sunday morning?"
Dr. McGill: "Yes. He won't mind."
Me: "But... what's he going to tell us? He knows the patient is on Zosyn. It was in his note. Do you think it's a mistake??"
Dr. McGill: "Just call him."
I was pretty horrified by having to do this, but like a good soldier, I did it. And Dr. Brown said exactly what I thought, which was that the Zosyn was for broader coverage. I honestly didn't get why we had to call him. Did she think that he was suddenly going to realize that he made a big mistake by putting the patient on Zosyn and Vanco? Dr. Brown is a really good physician and I know he wouldn't have made a mistake like that.
Anyway, this is one of the many reasons I hated weekend rounds.