* * Anonymous Doc

Friday, September 3, 2010

I did eight admissions overnight. This probably sounds terrible, but there's something relaxing about knowing that on this rotation I just have to admit the patients and don't need to follow them at all-- I never see them again once I do their initial workups and write their notes. If I make a mistake-- and I'm not saying I'm making any mistakes-- I'm not the one who has to deal with it.

What I don't think most people realize is that mistakes happen all the time. When I was on the regular floors, on the day team, it was not unusual to come in and find a new patient who had been completely mismanaged overnight. Wrong tests, wrong medications, wrong treatment plan. Hopefully not with any adverse consequences-- usually it just meant we had to start from scratch-- but there aren't really any checks and balances overnight. I'm given a patient, I do the workup, if I don't ask for help, it's assumed that I know what I'm doing and everything's fine. No mistake would be discovered until the morning. Unless it's some severe mistake that leads to a rapid response, in which case it's probably too late anyway.

A commenter on the last post said I was whining too much. And he (or she) is probably right. Compared to almost anything else I could be doing with myself, this isn't so bad. Even among things that fortunate people get to do, this is still pretty good. I'll make a good living, I'll be pretty well insulated from anything going on with the economy, I'll sound like a legitimate person at cocktail parties. But that doesn't mean it's not exhausting at times, and overwhelming, and frustrating, and sad. It can be all of those things in the moment-- and I can feel that while still knowing in the macro sense that I'm quite lucky.

There's more humor on the outpatient side, sure. And having not had regular clinic hours in a while, perhaps I've gotten a little dark over here. Clinic starting again soon. For now, all I've got is my patient last night who's doing a tour of the local emergency rooms.

"I was at County last week, then State over the weekend, and University on Tuesday-- they all said I didn't need to be admitted, and should follow up with my primary care physician, but I still wasn't feeling right, so I thought I'd come back and try you guys."

"Yeah, you still just have a cold."

"But I feel like I'd be more comfortable in the hospital than at home."

"Yeah, but we're not a hotel."

"I can't just stay for a couple of days, ride this one out?"


"You know of any hospital that might be more willing to let me stay over?"


I would have called social work for a consult... but it's the middle of the night. I gave him the number for social services-- I don't know, he doesn't really have a medical problem, but I sense he'll be back.

And now... sleep.


  1. Mistakes happen all the time at my job too and I say, "Well, at least I'm not a doctor so no people die when I make a mistake." But it seems like the medical system is little more interested in avoiding mistakes than my plastic factory is.

  2. Good post. I feel ya. Did seven consults in six hours last night, slept five hours, then did the first one at 7:30 this morning. It never stops. Did NOT admit most last night. I'm like you in that after over twenty five years of direct care in all kinds if settings, I'm enjoying seeing ED consults, solving the immediate problem, then turning the ongoing care over to someone else. Not a bad thing, just a different thing than I've been used to fit many years.
    Thanks for writing.