Tuesday 28 October 2008

Today was almost one of those “take the patient to the ICU and damn the consequences” type days except the patient died before I had a chance to get a good head of steam worked up. Now that I have been here for some time it’s interesting to me how different the various wards are. Since I take call (“second call”) about seven times a month I consult during the day one surgical patients with fevers and the like and then help the M.O.’s at night with difficult cases. Lately I’ve been able to visit Ob-Gyn, Surgery, and Ortho for simple stuff and have been impressed how the nurses gather around me and listen intently as I explain the pathophysiology of whatever and the best approach to it. They greet me as I come onto the ward and always are very professional.

The nurses of the male and female medical wards would have a difficult time being any more ambivalent. Today we had a woman crashing on the female side and getting a nurse to a) show interest and b) move was horrific. The passive aggression of the wards is deafening. And I think we share the fault to some extent. The HUP (read Penn) mentality can really come on strong and is somewhat off putting, even to an Oregon family doc like me. Apparently when this all began six (?) years ago there was a service of HUP only providers and as can be imagined the culture clash was significant.

This isn’t to say that this hasn’t been addressed and to some extent remedied by us but it is a long way from even and easy. And the patients suffer. We had two clean kills in four days where the nursing service admitted an unstable patient and dutifully noted that he was so, didn’t notify anyone and the patient quietly and inappropriately died.

So there’s one of the challenges. The nursing service isn’t used to questioning the wisdom of the admission and doesn’t see its role as doing anything other than carrying out the orders of the doctor. Hence; no orders-no therapy. Many has been the time we are blithely rounding only to find a patient admitted from last night that is unstable with nursing notes confirming that. On any other unit the nurses would be acting in the advocacy of the patient and would be notifying the world. Why not the medical wards?

The biking is great and my back is sore from the weird confirmation of the thing. Never the less I’m a happy guy. The flat is torn up at the moment as many tiles were loose and are being replaced, a good if very dusty thing. I’m hoping to get a peds gig in mid December to mid January as things slow down in outreach.

Best to you all. I Love hearing from anyone via the blog or e-mail. It makes my day.