During residency, I had a vacation day scheduled for a Monday. I told my attending Dr. Amnesia about it on Thursday, since I knew she was going to be off on Friday.
Well, when I came back on Tuesday, I found out from other residents that Dr. Amnesia somehow FORGOT that I was taking a vacation day, and was panicking and paging everyone when I didn't come in Monday.
Best of all, when I returned, I was hoping Dr. Amnesia could fill me in on any updates from the day before on the patients on our service (each service had one attending and one resident). She completely refused. She said, "Well, how do you think you would find out what happened with your patients? You could read the chart, couldn't you?"
Yeah. Or you could just take five minutes and TELL me.
How dare you take a day off and cause ME all of this grief? You say you told ME, but obviously, you didn't or I would not have wasted MY time looking for you. It is all about ME! You inconvenienced ME, therefore, you and your patients will now pay for it. (Oh, and I don't know what is new with the patients because I took Friday off.)
ReplyDeleteGeesh. TCG
Don't know if you are really looking for an answer or not. It's unlikely she has all patients' details from the previous day memorized so she would have to re-read the charts to answer this request. Why would she read charts to prepare for your return to work? Am I missing something? Just one patient maybe?
ReplyDeleteI can't even imagine what would have been said or done to me if I had asked for this.
So if one attending is handing off a census of patients to another attending, the hand-off should essentially be, "Read the charts because I can't remember anything"? In my experience, that's not how medicine works.
DeleteApples and oranges. Handing off patients you have just been working with the past few hours is different than both of you showing up in the morning, which is what you describe. I probably couldn't tell you the name of a single patient from last night without looking (I'm in EM though, so ADD and all of that).
ReplyDeleteTo better illustrate, I would have gotten the following "Oh, yes, by all means. Allow me to suspend my normal beginning routine and go through all the charts from yesterday and summarize them for you. I'm sure the outgoing doc will be happy to wait while I do that. You just wait right there while I do your job for you. Would you like that summary typed, written in calligraphy or a Power Point presentation with animated graphics?". (I had about the most sardonic/sarcastic attending ever, I can actually HEAR his voice, and this would have dragged on and on).
I don't have an intern/resident, but the other doc here tonight does. He says if he was asked that, he would order a summary of last night's patients be waiting for him when he arrived from that point on. (He would relent after his point was made, he is all talk)
Yes somehow, miraculously, the other attendings I worked with were all able to give me a five-minute update on any significant events with my patients from the day before if I was ever out. I guess they were all blessed with super amazing memories. And they didn't do it in Powerpoint. They just said, "Mr. Smith got his trach out yesterday. Mrs. Jones didn't do well on her voiding trial." Not too hard to spend a few minutes running the list.
DeleteBut if you work in EM, I can see how you might find that incredibly difficult and find my request unreasonable. Every patient is new to you all the time and probably a lot happens quickly. In rehab, it's like watching grass grow. We know the patients like they're practically family members, so asking for an update on them is like saying to Mom, "Anything new with the family last week?" Usually it's very little, often nothing, but it helps tremendously to hear the highlights. Her answer could easily have been, "Everyone is status quo."
Fair enough. It's been a long time since my inpatient rotations.
DeleteI'm surprised that her pettiness won out over her desire to help you deliver safe and effective patient care. Am also surprised anyone would think that you should get all of your information from the chart notes. Then again, we find all kinds of personalities in medicine.
DeleteMy residency training experience suggests that an attending should know her patients and their hospital course exceptionally well. It used to impress me, but over time I realized that it's a major aspect of how they competently supervise patient care.
It's fine if they can't recall the most minute details (as one can look to the medical record for that), but if they can't remember that the patient was started on antibiotics for a resistant UTI, had a spike in the WBC count, or had a fever workup then they ought to keep notes for their own reference, as they can expect to be asked about their patients by other team members at any time.
One can assume the resident should and would look through the chart notes as part of the daily routine, but a brief summary of key events (whether overnight or over the duration of your vacation) is part of the patient handoff we are obligated to share at the end/beginning of every coverage shift.
I didn't answer your question. Yes, handing off a census to another attending (who had maybe not seen any recently) would be an appropriate time to do past chart review and summary. Just not for a resident who was out yesterday.
ReplyDeleteAssuming this was inpatient rehab? Would you need more than a half second's glance at the chart at the next encounter? Even as a resident I could do months or years of past visits as fast as I could turn pages.
Your attending stories make me so glad I haven't met a jerk/annoying/etc attending yet!
ReplyDeleteAnal, quirky, old fashioned and strange however..