The last couple nights on pain night float have been complicated by the fact that the new interns have apparently begun taking call. It doesn’t seem like that long ago I was beginning internship, but it’s already been three years.
As I look back at some of the earlier entries in this blog, I see some rather indignant posts describing my calling consultants who seemed to think we hadn’t done an appropriate work-up. Even last year, I remember calling a cardiology consult for a stat echocardiogram in the ICU for a crumping patient (because the fellow wanted one), and the cardiology fellow was still a jerk about it.
Alas, I am now that consultant. Last night found me returning a page from an intern who told me that his patient with a thoracic epidural catheter was having pain. This was a very reasonable consult, but the intern couldn’t tell me much about the patient’s medical history, couldn’t give me more details about the patient’s pain, couldn’t tell me where the catheter was, how deeply it was placed, which medicine was being infused through it, and at which rate. He stammered, “This is my first night on cardiothoracic, and I’m just cross-covering that patient.”
I responded, “You are that patient’s primary physician for the night, and you should know more about the patient than anyone else in the hospital. You should know all these things before you call a consultant. I wouldn’t dream of calling a cardiology consult if I couldn’t recite a brief history, and if I didn’t know what the last troponin was and what the EKG showed.” Of course, I said it all in a nice–but firm–tone of voice, and the chastened intern apologized to me when I showed up on the floor. I told him I wasn’t upset, but that it was important for him to learn sooner rather than later how to appropriately ask for help from a consultant.
This morning I received yet another page. “This patient had back surgery and is having pain. Could you come write a PCA?” Again, I asked for more details, and at first the intern couldn’t tell me the patient’s medical record number, when the surgery was, and what pain regimen the patient was on. For him, I simply said, “It sounds to me you know very little about this patient. Please go look up the information and then you can call me back.”
In this case, I was busy and I didn’t have time to wait while the intern looked up every detail I asked for. Sure, I could easily look up all the information, but it’s inappropriate not to be able to tell a consultant pertinent details. I felt like this intern just hadn’t really bothered, and that conveyed the message that he felt like his time was more valuable than mine.
Ironically, I’m sure he did have a lot more than me I to do that morning, but I think he still got the idea that he needs to know his patient before calling the consultant. I think of it as tough love. You can’t coddle these interns who just spent the last six months skipping through an easy end to fourth year and being told how bright they are. Better to work hard and to be prepared than to be bright.