"I Was Hoping A Doctor Would Come See Me Today."

I'm on call this weekend, and had to go in and round on the patients in the morning.  I met one woman yesterday, 90 years old and very pleasant.  We had a very nice chat about how she was feeling, I did a physical exam, checked her recent labs, and wrote a note.  She thanked me for coming to see her and said that my visit made her day.  I finished rounds around lunchtime and felt pretty good about myself.

An hour later, the pager buzzes.  I call back.

"[Patient] is complaining that a doctor hasn't seen her yet.  She said she's been waiting all day for a doctor, is very upset that no one has examined her.  Wanted to speak to whoever was on call."

"Uh, yeah, I saw her today.  We had a very pleasant conversation.  She's stable, doing okay."

"She says no one saw her."

"I wrote a note.  Though I'll admit, I didn't notice any dementia.  But this was my first time seeing her."

"There's no dementia in her chart."

"Okay, well, I guess that's something to work up during the week."

"And you're sure you saw her?"

"I wrote a note!"

"So?"

"So I don't write notes on patients I don't see!"

"Come on, we all do."

"I saw her.  Tell her I'll see her again tomorrow."


Two hours later the pager buzzes again.  Same number.  I call back.

"[Patient] is insisting no one saw her today."

"Didn't we have this conversation already?"

"Did we?"

"I saw her.  I wrote a note.  We talked about it."

"I'm sorry, I really don't remember."

"Okay, I think we have to work you up for dementia too."

"You're sure you saw the patient?  She's very insistent."

"I wrote a note!"

"So?"


"So I don't write notes on patients I don't see!"

"Come on, we all do."

"I saw her.  Tell her I'll see her again tomorrow."

"What's the point?"

I'm testing a new patient for dementia.  Her family says they think she may be depressed.

"Can you count backwards from a hundred, by sevens?"

"100, 93, 86, whatever, who cares what's next...."

"Do you know who the President is?"

"Does it matter who the President is?  They all do the same garbage."

"Do you know the year?"

"One year later than last year.  Ugh."

"Can you write a sentence on this piece of paper?  Any sentence you want."

Writes: "What's the point?"

"Do you think you may be depressed?"

"No.  Who told you that?  My daughter?  She stinks.  My fault, of course."

Thoughts From The Depression

I am with a new 96-year-old patient:

"Where are we?"

"A bank."

"What year is it?"

"1929."

"Yeah?"

"Yeah."

"How's the economy?"

"Oh, you know.  Not so good."

"What are you doing here?"

"The normal things you do in a bank."

"And what are those?"

"You know.  Taking out money."

"Do you have a lot of money in the bank?"

"Not as much as I used to."

"What if I told you this was a hospital?"

"Well, I wouldn't be surprised.  Banks have to do all sorts of things to make money these days."

When Doctors Forget How To Use Computers...

I sit down at the computer at the nurse's station to write a few notes.  A bunch of windows are open on the screen.  I open a new window and log in to check my work e-mail.  I click back to the notes system while the e-mail is loading.  I start to write a patient note.  I go back to the e-mail and I see a couple of unread messages.  The first is from a family member of a patient whose name I definitely don't recognize.

"I had a question about my father's medication..."

Confused, I write back a short note.  "I think you may have sent this to the wrong address."  I push send and go back to the notes system.

I finish the note, and click back to the web browser.  That's strange-- the other unread messages don't seem to be there, and the one I just read and replied to isn't there either.

I notice there are two browser windows open.  I click on the other one, starting to panic.

It's another doctor's e-mail window... and the system has just logged me out automatically.  I see the login name and I realize what's happened.  An attending-- an attending I've never met-- forgot to log out of her e-mail.  I read a message from one of her patients... and answered it.  And now I'm logged out and can't even correct the mistake, or remember the name of the patient.

The right thing to do, I suppose, is to e-mail that doctor and try to explain what happened.  "We haven't met, but I'm a new fellow.  I didn't notice that you were still logged into your e-mail at the nurse's station, thought it was my e-mail, and accidentally read a message from a patient family, though I can't recall which one, with a question about medication, and wrote back that I thought the e-mail may have been sent to the wrong address. And by the time I realized my mistake, the system had logged you out.  Also, I'm not usually this incompetent."

Alternatively, I can quietly pretend this never happened.  The family will probably resend the e-mail, or call the office.  The doctor may notice a strange sent e-mail, or maybe she won't.  She may be confused.

It would be so easy to pretend this never happened.  I'm untraceable.  I don't know how to send that e-mail to the attending I don't know without seeming like a crazy person.  I read her e-mail?  I replied to one of her patients?  It's not like I said something so crazy.  It's not like it was an emergency.  It's not like I deleted the e-mail.  It would be so much easier to pretend this never happened.  I really don't want to send that e-mail.  I really don't want to send that e-mail.

Doctors have to make hard choices sometimes.

"You Stole My iPhone"

"Hey, [Mr. Hospital Patient], the nurse paged me and said you needed to talk urgently?"

"Yeah.  You lost my glasses and my iPhone."

"I never had your glasses or your iPhone.  What happened?"

"I went for an x-ray, and the nurse said she was putting my glasses and my iPhone in my bag and locking them up.  I came back and they unlocked the bag-- and they're missing."

"Wow, I'm sorry.  But I'm not sure I'm the right person to talk to.  You should ask the nurse who locked them up.  Maybe they're in another bag."

"That nurse is at lunch.  This other nurse said there's nothing else locked up.  So I think that nurse stole them."

"I'm not sure why anyone would want to steal your glasses.  And I'm sure if a nurse said she was locking up your iPhone, she wouldn't steal it."

"Well, you owe me a new iPhone."

"Let's try and talk to the nurse first and find out what happened.  Can I see the bag?"

"Why?  So you can steal something else?  My dentures are in there."

"Okay, I don't want your dentures.  I just want to make sure nothing's hiding at the bottom of the bag."

"You think I'm crazy?  Of course I looked through the whole bag before I told them to page you.  I didn't want to waste your time."

"But let's just make sure.  Since you pulled me out of rounds anyway, I may as well be thorough with the search."

"They're not in there."

"Okay, but let's just make sure."

[He hands me the bag.  I feel the bag for a moment.  I find a side pocket, unzip the zipper, and pull out his glasses and his phone... which is not an iPhone.]

"I think I found your glasses... and this cell phone.  Although it's not an iPhone...."

"Uh, yeah, that's my phone."

"You said you had an iPhone."

"I just figured if you guys were going to get me a new phone anyway, I may as well get an iPhone."

"Okay, I'm going to go back to rounds now.  I'll check in on you tomorrow."

Percent Chance

"Last week, the surgeon said it was probably 50/50 that my mother would lose her leg.  I wanted to know what the chances are now."

"I'd defer to the surgeon, but I think they're about the same."

"So, like 55/45?"

"I don't know.  It's about the same as it was."

"About the same, or exactly the same?"

"I don't know.  I'd defer to the surgeon."

"But I want to know if it's more like 55/45, or 45/55."

"I don't think we can quantify these things exactly.  We don't know how she's going to respond to the antibiotics."

"But if you were betting on it, which side--"

"I'm not betting on it.  This isn't a racetrack.  We're trying to make the best possible decisions for your mother's health."

"But should I be telling the rest of the family that she probably will lose her leg, or she probably won't?"

"I don't know.  You can tell them you don't know.  You can tell them the doctors do not know yet."

"I want to give them a more specific answer than that."

"I don't have a more specific answer for you."

"Can you ask the surgeon if his odds have changed?"

"You can call the surgeon's office and ask for him to call you back."

"And what are the odds he'll call me back today?  Are they 50/50, or more like 80/20?"

"I don't know."