* * Anonymous Doc

Monday, December 21, 2009

During rounds this morning, we were dealing with a patient with a grossly enlarged testicle, and the attending puts his stethoscope right on the thing, no sterile cover or anything. Next room, elderly woman, he puts the stethoscope right on her chest. Didn't clean it in between or anything.

I wanted to say something. Something like, "doctor, did you wipe that down?" but it's so hard to question anyone. It's different for something major-- I was reading one of the notes that an attending wrote on my patient, and noticed he didn't mention the potassium level, which had come back crazy high in the lab work. So I called him to make sure he saw that, and it turned out he hadn't, and we had to add a couple more pills into the mix. But in real-time, in person, it's hard to question an attending, especially when it's "just" about cleanliness and not about medication levels or something that you know is definitely going to mess up the patient.

But it gnawed at me for a couple of minutes, so I said something afterwards, phrased it like a question I didn't already know the answer to-- like, "I notice some docs are super-vigilant about the stethoscope, but it varies-- is it overkill to be cleaning it between each patient, or should we try and remember to do that, every time?" And he said, yeah, we should probably do that every time, but he forgets sometimes, and it's bad form. And he cleaned it before the next one. And then forgot before the one after that.

Even though it's been almost six months of this, it's still hard to wrap my head around how thin the line is between 'patient gets good treatment' and 'something goes wrong'. The rotation I'm on right now, there's a systems problem-- it's all private attendings, they see the patients, they write their notes, but there's no central coordination of anything. It's up to me and my resident to keep track of the notes, and to keep track of the overall patient management, but we don't actually make any decisions, and we don't always know who has seen the patient, if they don't write the note right away. We have a guy who's being seen by a couple of different specialists, and they keep entering conflicting orders-- give drug X, says one of them. Stop drug X, says the next. Next day, same thing-- give drug X, stop drug X. They don't talk to each other, and when we call to resolve the conflict, they're both happy to defer to the other one-- but we haven't yet resolved it. We gave it one day, we didn't give it the next, we don't know which doctor is right and neither do they.

1 comment:

  1. Wow. That's incredible, that discrepancy between the two specialists. --Miss__Tina