Wednesday, January 27, 2016

Friday afternoon

Years ago, when I was a medicine intern on the consult service, I got a page from the PA on the vascular service at 4PM on a Friday afternoon, the second I had gotten home because I thought we were done for the day.

The PA said to me, "Gee, sorry to be calling such a late consult, but... we need help with this guy."

The PA explained he was a 75 year old man who was about to go for surgery for revascularization of the leg, but they cancelled it due to pneumonia.

"So do you need help managing his pneumonia?"

"Well, we already consulted pulmonary about that, so they're managing his pneumonia," the PA said. "Also, he's having some blood in his urine."

"So do you want help with the bloody urine?"

"No, urology is already consulting on that." Thoughtfully. "He also has vascular problems in his legs, but we're managing that...."

"So what is your question for US?" I asked. .. that you're calling late on a Friday afternoon for.

"Um.... I guess we just need help managing all his issues..."

"What issues? You already have pulmonary and urology on board, so what are we supposed to do?"

"We just want to make sure there's nothing we're missing."

"But I can't say that to my attending. You have to have a question for us."


"Is there anything specifically that you want us to manage?"


Finally, I tried to help him: "Do you want us to clear him for surgery next week?"

"Oh... uh, okay!"

Of course, it was totally ridiculous. I called my attending and I was like, "I don't really know why they're calling about this guy. All his issues are being managed. They want us to get him ready for surgery, but he's already on a beta blocker. It's kind of a bullshit consult."

My attending said: "Are you already home?"

I admitted that I was. But who would have thought I'd get a consult at 4PM on a Friday? Especially when it's a very non-urgent consult.

The attending was nice to me and admitted that it was a bullshit CYA consult. She said I didn't have to come back to the hospital. Thank you to the attending who didn't make me come back to the hospital at 4PM on a Friday for paperwork.


  1. While it sucks that they waited so late to call you (which is really not cool!) at some places vascular surgery ONLY consults-they don't have their own team. At other places there is a medicine team specifically for the vascular surgery patients that they co-manage. At our hospital, vascular is its own service, but it seems like every patient has a handful of consults and the plan for the day is basically follow up on what all the other services want to do. There have been several large studies that show vascular patients do better when managed exclusively by medicine teams or at least co-managed. The patients are sick at baseline and while it's easy to start home meds and while we can mange acute issues (a lot of icu months) we have literally no training in tweaking care of chronic issues. My last medicine rotation was third year medical school. If it was three years ago for me, imagine how long ago it was for my seniors or our attendings.

  2. I know Oz is different but don't you hand over the someone?
    The medical registrar taking calls has a deck phone which they hand over to the next person when they go home... So they can't go home early... and if someone rings at 5:05, they get the night registrar...

    Do you not have cover overnight?

    1. Where I am there's an internal medicine inpatient team that has 24/7 coverage and an internal medicine consults team that takes care of ward consults 8-5 on weekdays. Nights and weekends the inpatient team covers new ward consults, but the day consult team is there to basically let the inpatient team focus on emerg admits and their own inpatients during the day. It sounds to me like Fizzy was on a consult team like that.