Wednesday, 17 August 2011

Tips for Junior Doctors part 5: DO wake your patients.

My patients and I survived the first night shift. I'm apparently not the type who is extremely sharp in the middle of the night. My sharpness returned with the sunrise... and my, what wonderful sunrise it is if it promises the end of a night shift.

Typically, there are two doctors on call (SHO/residents), a surgical one and a medical one. I'm the medical one. It's just me, and the entire hospital. Me, the wards, and emergencies.

And it was busy. I work in a relatively small hospital, in international standards. My phone kept ringing, a few sick patients on the wards who required attention, a random transfer in the middle of the night from another hospital ending up on the wrong ward because I didn't know the patient was expected and 'admit through emergencies' was misinterpreted, and an emergencies department which never got empty. Until 7:45AM when I sent my last patient home, and the patient arriving had blood all over him, which means it's surgical.

Surgical doc had phoned me at 11:30pm to ask if he could use one of the on-call rooms. He slept most of the night, and his ED patient arrived at a decent time. I didn't even have time to go to the medics room to eat something.

But then again I forgot that I have no appetite at night.

Because it was busy on Emergencies, I didn't have time to go and admit the misplaced patient before he fell asleep. I phoned the lung doc (patient got admitted to pulmonology) to let him know that patient is there... because really I had no idea how to go about this. Basically, the problem itself was something that required no immediate attention. Lung doc normally is a very nice man, but not when sleeping. I got burned down. Because I didn't wake a completely stable patient to take a history.

Actually the main thing that went wrong is that Ghost Doc saw said patient earlier in the evening, and sent the patient to a PCI centre who sent them back to us (because it turned out to be a suspected pulmonary embolism and not a heart attack). Ghost Doc wanted to finish off the case herself, and didn't hand it over to me. She fell asleep in one of the on call rooms, with the patient's chart. Ghost Doc's shift ended at 11PM, but she always haunts the halls of the hospital when she's not supposed to be there. I got phoned by the other hospital, who wanted the patient on a pulmonary ward, not a cardiac one. I didn't know the patient was already expected on the CCU, in the end the message was 'fine, send them in through Emergencies'. And they told the ambulance to go straight to the pulmonology ward. Had I know the patient already had a bed, we wouldn't have a problem at all, because I know that CCU nurses are capable of administering Fragmin, and are capable of detecting respiratory distress, and that the doc on the CCU is capable of organising a CT scan for the patient and transferring the patient to another ward after the friggin sheeth had been removed!

1 comment:

  1. So typical. I love how we get burned down for stupid crap, especially when we are taking care of sicker patients. Sounds like you just got caught in the middle of the poo storm. I hate waking people up but I guess if I don't get to sleep, neither do they. Haha.