I find myself making decisions by trying to figure out what Brad, or any of the chiefs, would do in such a situation. I figure they’re pretty likely to get it right, or at least not shamefully wrong, so imitating them is safe.
Unfortunately, this leads to such a strongly developed sense of responsibility that I stayed several hours late yesterday, keeping an eye on a couple of people with low blood pressures, and finally dragged myself out of the hospital on the grounds that it’s too soon to start staying overnight just for fun. It also obliges me to cut my planned holiday short in order to be back to help with some major surgeries. Professional responsibility is quite a nuisance.
The nurses at this hospital are driving me crazy. They arbitrarily decide to inform me, or not inform me, of various critical lab values and vital signs, and then call me desperate for help a few hours later. How do they decide that a potassium of 3.4 (normal 3.5-5.0) is worth paging me about, but urine output less than 20cc/hr for three hours (normal is at least 30cc/hr) is not worth telling me about; or that they’ll page critical care to ask about anemia in a surgical patient within 24 hours of surgery, but they’ll page me to ask about hypoglycemia in a patient on an insulin drip? Why do they talk to critical care for six hours about the hypotension, and then when I walk by start pointing out the tachycardia? After a few of these pile up, I gingerly tried to point out that I am, whether they like it or not, the doctor responsible for these patients, and the representative of the primary service. And they have a nice fancy explanation, so I back down, and am left fuming inwardly. I do so want to get back to my own house, my own hospital, where the nurses know my name, where they’re not afraid to let me know about vital signs and lab values, and where, when they feel obliged to fix my orders, they at least tell me about it afterwards. (I discovered today that one of the nurses here, the one who thinks that not even the attending needs to see the wounds if she feels ok with them, has been routinely crossing out my orders and adjusting them. I still think she knows better than me about a lot of this stuff, but you would think she might tell me, if only for future reference!)