Me: Uh, don't take this the wrong way, but can I make a suggestion?
Intern: Sure
Me: I think you should delete the note you wrote on Mr. Johnson in room 123 today.
Intern: Why?
Me: Well, you wrote 'no acute overnight events. Tolerating PO. Pain controlled. Pt is improving. Plan: OK to D/C to home tomorrow'
Intern: So?
Me: Uh, yesterday he developed projectile vomiting, I ordered a CT scan that showed he had a massive bowel obstruction, I consulted general surgery and they took him to the OR and did an exploratory laparotomy with bowel resection, he went into atrial fibrillation postoperatively and the Rapid Response Team was called, he was then started on coumadin. We've had 2 nasogastric tubes in him and he keeps on pulling them out. And I ordered a urinalysis yesterday and it was positive so he was started on Levaquin.
Interns, man.
(Although it was the last day of his intern year so I was willing to give him a pass for that one, but starting tomorrow...)
Maybe he got confused when he got busy? I'm not saying that's right but you do want them to learn from their mistakes. That a MAJOR problem I have with doctors. Let us work through this TOGETHER - and not all of us want lawyers in the picture, so you need to figure out whether or not you do or not. I can deal with pretty much anything but when you shut me out, that's another story. I have pointed things out to docs, by way of medical research, as that's all I read. As long as they can deal with that, its all good. :)
ReplyDeleteI don't need a doctor who is perfect (it would be nice but not expected) but someone who is willing to learn and work thru problems. Apologize and we fix it. Lets be a team that doesn't need hospital admin and lawyers to solve things together. That way we can justify having less of them. :)
What? The intern obviously didn't see the patient or even read the chart. He lied. That is an inexcusable thing to do.
DeleteSeems like the intern simply lied about seeing the patient and got caught...
ReplyDeleteMaybe he wrote the note before all those things happened?
ReplyDeleteoh didn't see that the note was written the day after. my bad.
DeleteBeing generous - the intern was confused about which patient she was charting on. Less generous, well... busted!
ReplyDeleteMaybe, just maybe, the patient didn't have any acute OVERNIGHT events. And, maybe his pain WAS well controlled (although the definitive sign is when the patient pulls out his foley with the 30-cc balloon and flings it around the room). And, it sure sounds to me like he is improving - anything is an improvement over emergency SBO surgery, acute AF, and urosepsis. So, except for the bit about being ready for discharge, the intern's note wasn't ALL wrong! (You can bet on it - he never saw the patient - busted! You have to nip that behavior in the bud!) Tricia, RN
ReplyDeleteDr. Orthochick is being too kind.
ReplyDeleteWhile what the intern was completely inexcusable... why start warfarin immediately post-op for a fib that is not likely to persist? Not that you should anticoagulate with warfarin acutely anyway. And are you treating asymptomatic bacteriuria or an actual symptomatic UTI?
ReplyDeleteSurgeons, man... ;)
I would have serious reservations about letting that PGY1 progress... Obviously had no clue what went on with his patient. You want him supervising first day interns????
ReplyDeleteI would tell your chief/program director asap.