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I could never understand this. I ...

Posted Nov 16 2009 10:03pm

I could never understand this. It has been happening since the days of internship. It happened again today as a surgeon and again I had to insist and scream my way through!

In my years of service, one of the things I hate is when you refer dire emergency cases to another department. However, I also notice my own colleagues doing the same. No doubt non emergency cases should be referred with details of necessary relevant points. However, emergency cases do not allow for such in depth details. Time is of the essence and when the primary team calls then one should respond by being at the ER quick. Another issue is that when the ED doctors call to refer, ( well in Malaysia, most ED doctors consist of post intern doctors)why do some harass them for hours over the phone. They call because they are not sure. Of course, there are some ED doctors which I have come across that called me for an abdominal mass in a lady when the poor lady had a gravid uterus. If such blatant mistakes can be made, then it is more so that one should just move their butt and see the patient upon referral. Would asking more questions to such an ED doctor ease your irritable and already tired self? But I digress, that was ED to primary team.

So how about primary team to other speciality colleagues, especially when the person who made the call is a specialist? Am I angry, oh yes I am?

I was doing upper endoscopy today, when the endoscpic nurse informed that there was a case for urgent upper endosccopy(OGDS). I was at my last case and the other surgeon was doing a colonoscopy. So after preparing the patient, we proceeded with the OGDS. She was having a fast pulse and her blood pressure was at the lower limit of normal. She was obese and had two lines. She is a diabetic and presented to the orthopaedic department with gas gangrene and a fast spreading infection reaching the upper left thigh and her right hand till forearm. For this, the had to disarticulate her at the hip joint and and amputate one or two of her fingers. She had an episode of upper gastrointestinal bleed about three weeks ago which revealed a duodenal ulcer with no active bleed and was treated with proton pump inhibitors. Of all days, she bleed again this morning and was rushed to the scope room. A scope was introduced and at the same ulcer site which now looks bigger and had an active spurter. However, before anything could be done, she desaturated and her blood pressure started to fall.I withdrew the scope and sadly found that all her lines were bunked. Though dazed and confused, she managed to put some resistance when I tried to place an oropharyngeal tube. With that I requested assistance from the anaesthetic department. The anaesthetic medical officer was asking my doctor a hundred questions before telling her he would like to speak to me - like I had the time for this nonsense - I took the short cut - I shouted from across the room so that he could hear me through the phone! Damn! The things I do to get the message across their thick skull! The reason - well he and his specialist have discussed the case early in the morning and decided that she is not to be intubated due to her poor quality of life and poor outcome! My issue is I have a lady bleeding away and I can confidently stop it! Shouldn’t I push it?!! So angry I may be, I asked this obtunded anaesthetic medical officer whether the present scenario ever crossed their discussion! I can understand that decision if she worsens from infection or her heart weakens or as such but bleeding that I can stop - never! He timidly said they never discussed this. We got her lines and intubated her and subsequently I clipped the bleeder. The bleeding stopped but she lost the battle to infection.

Don’t you think? Why waste precious time but just come and assess for yourself rather than trying to assess the validity of the referral over the phone? A call in an emergency means ones assistance is needed. Drop your ego, show some sense of urgency and come to assist. Then if one has an issue then the discussion is a more valid one, rather than hearsay, don’t you think?

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