a lot to learn
I’m doing a rotation in the Emergency Department at the moment. And mostly I’m really enjoying it.
Like every rotation there’s a mixture of senior clinicians, some who are excellent mentors and colleagues and others who really don’t seem to care much at all. But that’s another post.
I’ve had some great clinical learning moments, but also some important learning about systems.
The other week I had a patient who had attended ED with a letter from a specialist outside of the hospital. It was short and addressed to a senior clinician in the hospital and referred to a senior registrar stating that he had said to send the patient into ED for further management as the patient had been under that team only 1 week previously. The patient was not acutely unwell - stable, not in pain, but also clearly not improving since recent admissions.
So, I took a history, did an examination and ordered some bloods. Then I called the registrar. He knew all about the patient and went on to explain that the senior consultant mentioned wasn’t the correct one due to some confusion about teams on call a few weeks ago. He said to call another registrar who knew about the situation and would see the patient.
The second registrar asked me about my findings and results and then promptly declined to come and see the patient. I was honest and direct with him, as I didn’t feel the patient was acutely unwell - certainly they needed follow-up but it didn’t have to happen immediately (as a side note, the external consultant could have done all of this but appeared to be handballing the patient). It didn’t seem like an appropriate referral but I had felt the pressure to do the bidding of an external consultant who had been in touch with a team within the hospital. The external consultant had also given the patient and family a certain expectation about admission and further investigations in hospital.
It may read like all of this happened very quickly, but this is over the course of 3 hours or so while I was also seeing other patients and doing a handover at the end of my shift.
So, what have I learnt?
Even if there are letters from consultants and plans made for a patient outside of the ED, workup the patient and refer them on as necessary. Certainly contact the teams involved, but focus on what the patient needs. Try and find a solution for their problems.
I’ve also learnt that when I’m on a receiving team I certainly won’t be telling a patient to come to ED and then not seeing them.
