A middle-aged woman was admitted to the medical service for symptoms of alcohol withdrawal. Her liver function tests were abnormal. Despite the fact that she had no abdominal pain, an ultrasound was ordered and showed a gallstone. The cognitive doctor called me and said he didn't think the gallstones were significant but would like me to see the patient and confirm his feeling. Asymptomatic gallstones do not require surgical intervention. Why can’t a cognitive doctor deal with this himself?
An emergency physician had a woman in the ED who had fallen down some steps and fractured her right humerus, clavicle and a rib. There was no history of loss of consciousness. Her total body CT scans were otherwise negative. He consulted me to "clear" her regarding possible other injuries before deciding on her disposition. Are ED MDs capable of assessing and "clearing" trauma patients or not?
A man was admitted to the medical service with gallstone pancreatitis. [Whether such patients should be admitted to medicine or surgery will be the subject of another discussion.] I was called for a consult at 2:00 a.m. Think about it. How likely was it that I was going to operate on this patient in the middle of the night? Hint: Not very.
The answering service of a surgeon I was covering for called me at 5:00 on a Sunday morning to tell me that a woman had called to say her husband, who had undergone surgery a few weeks before, was having pain. I called the number I was given, and the call went straight to voice mail. Through clenched teeth, I left a message stating I was returning her call and that if she wanted to talk to me she should leave her phone on call the service back. When she called back a while later, I learned that the pain had been going on for more than 24 hours. Why couldn’t they have waited two more hours to call? And how about leaving the phone on to receive the call-back?
A patient of another surgeon I was covering for called me at 6:00 p.m. on a Friday to tell me he had just run out of pain medication. Wouldn’t it make more sense to call the doctor for a refill when one was down to say, two or three pills? By the way, this happens all too frequently. It always makes me suspicious that the patient is drug-seeking. They get just enough pills to last the weekend.
I was called to the ED to see a morbidly obese woman with an incarcerated ventral hernia. While taking a history, I learned that she had diabetes, hypertension, asthma, sleep apnea, hypercholesterolemia, arthritis, atrial fibrillation and was taking prednisone and Coumadin, as well as 15 other medications. Her primary care physician, all of her specialists and the surgeon who had performed all of her previous operations practiced at another hospital. Why did she come to my hospital? She said she knew she wouldn’t be kept waiting as long in our ED.
Horace Greeley: “Common sense is uncommon.”
Skeptical Scalpel: “Common sense cannot be taught.”