I call up the resident and describe the case. High white count. Ugly ultrasound. The patient looks sick. She got her antibiotics and an IV fluid bolus. The resident asks about her medical history. Actually, the patient was fairly healthy. She had controlled hypertension, a bit of arthritis in her knees, and that was it. Heck, if it wasn’t for this gallbladder looking like some sleeping bat hanging upside down off of her liver, she’d be in great shape.
“We’re not taking her. You’ll have to admit her to General Medicine for pre-op clearance and then consult us.”
“OK, fine. I’ll admit her to medicine, but you’re still going to need to come down here and see her.”
“Did you consult Ortho?”
“What about her knees?”
“You said that she had arthritis in her knees.”
“So? She’s had arthritis for 10 years.”
“You’re going to have to call an Ortho consult.”
It was the end of the shift and I was getting irritated.
“Listen. Maybe you didn’t hear me. This lady is sick. I’m not consulting Ortho for a chronic knee problem. I’m not consulting Dermatology for the zit on her forehead. I’m not consulting Plastics for the frown lines on the bridge of her nose, and I’m not calling Psych because she forgot the name of her antihypertensive medicine. Now get down here and evaluate the patient.”
“Never mind. Just let Medicine know about her and send the patient upstairs. I’ll see her when she gets to the floor.”
This interaction made me wonder about the apparent lack of insight about the urgency of a bad gallbladder over chronic arthritis in the knees. Is our residency training getting so specialty-specific that the graduates no longer feel comfortable providing basic medical care in other specialties?
“Sorry, you’ll have to go to the “high risk” hypertension clinic. I only treat systolic pressures up to 170.”