I ran into one of the critical care fellows the other day. “I hear you’ve been stepping on my attending’s toes,” he told me.
I wasn’t sure what was coming next, and I really didn’t feel like apologizing for protecting my patients, so I answered cautiously: “It felt to me more like he was the one stepping on my toes.”
“Oh, he does that all the time. People hate it. When he’s not yelling at you, he’s playing turf wars.”
Seeing that this was a moaning session and not another episode in the turf wars, I told him my story, and he traded me an even worse one, seeing that it happened inside of the pulmonology service. He left me with the impression that the MICU inhabitants were quite pleased to have the surgery residents acting as surrogates in their quarrel with this attending.
So I won’t go out of my way for this attending in either direction: I’m not out to pick a quarrel, but I’m encouraged by this encounter not to stand for any territory grabs towards my service.
Cut On The Dotted Line 
July 27, 2008 at 2:28 am
Nice to be validated. Would be even better if the senior fellows would step in themselves though….
July 27, 2008 at 8:48 am
Hate to keep Hatin on the Internists, but thats how they are.
July 29, 2008 at 12:02 am
I saved a surgery patient the other day. Though she was a Type 1 diabetic, her surgery team stopped her insulin pump, and though she has only one working coronary vessel, they stopped her beta blocker, aspirin and plavix. She went into DKA and had a massive NSTEMI before we took her from the surgery team.
I sincerely hope that at least one of the residents on that team remembers that diabetic ketoacidosis can present with abdominal pain, and that it isn’t always appendicitis. Oh, and don’t stop the plavix of people with drug eluting stents. Serious party foul.
July 29, 2008 at 7:52 pm
Wow, Nathan, touche’. That’s really awful. I’d say I hope I wouldn’t do that, but I’ve done my share of dumb things by now; ask the cardiologists I’ve consulted. . .
What kind of surgery was it?
(There you go, I’d more interested in the operation than in how high her sugar got or what the anion gap was. 🙂 )
July 29, 2008 at 9:52 pm
🙂 Intensivists don’t really care how high the sugar gets either. The gap is the issue.
The kicker is she didn’t even get a surgery. The surgery team admitted her, discontinued all her meds, and then sat on her for two days trying to “cool her off” or whatever it is they term malignant neglect. It was only when she had chest pain for 12 hours “like someone standing on me” and she started breathing like 40 times a minute and had a gap of 27 that they called me.
July 30, 2008 at 8:45 pm
Ooh, ouch.
You should be happy to hear that as I was standing with a critical patient for two hours this afternoon and telling the nurse that no, we didn’t need to consult critical care, the chief and I could handle it – whatever “it” is, we still don’t know – I was thinking in the back of my head, “What would Nathan say about this?” Congrats, you’ve joined about two other doctors who talk in my head when I’m puzzled. 🙂