tag:blogger.com,1999:blog-11034229.post116964710560371297..comments2023-07-14T02:53:40.719-07:00Comments on retired doc's thoughts: Hand off problems or lack of personal responsibility by physicianjames gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-11034229.post-41077312762737652722007-06-29T08:05:00.000-07:002007-06-29T08:05:00.000-07:00Residents aren't the only ones "signing out." A l...Residents aren't the only ones "signing out." A lot of PCPs hand their patients over to hospitalists when they are admitted, because they just don't have time or energy to admit patients to the hospital and write inpatient orders after a full day crammed with outpatients. A patient calls at 2 AM with SOB - is the PCP going to run over to the patient's house? Please - he's going to say, appropriately, "Go to the ER," where they are most able and ready to take care of this patient, and go back to sleep.<BR/><BR/>Plus it's probably safer having a doctor in the hospital at all hours rather than relying on the private physician, even though he/she's "their doctor." <BR/><BR/>Doctors want the kind of comfortable lifestyle that they deserve, and if that's going to be the case, someone has to come up with a reliable system of handing off patient care to other doctors - there's no way around it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-19717307567263211342007-01-31T16:44:00.000-08:002007-01-31T16:44:00.000-08:00Having many friends in academic surgery, the theme...Having many friends in academic surgery, the theme seems pretty universal: concern about where we're headed (or, rather, are being taken) in the training of physicians. They are alarmed at the "shift-worker" mentality, and the loss of personal responsibility. (Of course, we see that at the national political level in spades). Not to mention the diminished experience of those completing training.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1169924256744845062007-01-27T10:57:00.000-08:002007-01-27T10:57:00.000-08:00I am an intern. I've seen the problems inherent in...I am an intern. I've seen the problems inherent in signout. I know how difficult it is to communicate all the important points about a patient to the nightfloat intern/resident, let alone making sure they follow my overnight "to-do/to follow-up" list. I've also been on the flip side of things as the nightfloat intern. Despite what the critics say about the dangers of handoffs to nightfloat personnel, I think the "system" does work at my institution. My nightfloat rotation taught me how to be a better ward intern and make signouts effective. It is not uncommon at my institution that interns and residents ask that they themselves be notified about their patients even when they're signed-out and gone home and nightfloat is on the job---even for residents in the ICU.<BR/><BR/>My residency program is constantly looking for ways to improve patient care and to do so without unnecessarily extending work hours. And I personally am always looking for ways to improve the way I care for patients, including thoughtful and effective handoffs. As the nightfloat intern, I found it useful to read all of my patient lists and highlight things to do or follow-up on, even if the ward team hadn't indicated that I do so. Then I'd make my own to-do list, including the times that I expected labs to be back. I also learned to be proactive and call the floors to alert them that Mr./Mrs. So-and-so had a lab draw scheduled for "x" o'clock. It can be frustrating to expect a lab result at 4am, only to find that it was never drawn.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1169901046740684432007-01-27T04:30:00.000-08:002007-01-27T04:30:00.000-08:00Dr. Van Tessel-thanks for your thoughts.Good to he...Dr. Van Tessel-thanks for your thoughts.Good to hear from you again.james gaultehttps://www.blogger.com/profile/05537303135780186926noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1169880870057234032007-01-26T22:54:00.000-08:002007-01-26T22:54:00.000-08:00So tonight, in the 15th hour of my day, I signed o...So tonight, in the 15th hour of my day, I signed out a lumbar puncture. And, as I often do after sign out, I finished up putting orders in and did a little paperwork. Then I overheard that my encephalopathic patient was refusing the LP, the LP I'd consented her for, and night float was thinking about starting empiric IV antibiotics. I walked out to the parking lot wondering what the patient would look like Sunday, after my day off, after day float had a day to ignore whatever night float was going to do. The real answer is not strict adherence to this magical idea of an 80-hour week but less patients per resident. Because when I'm carrying 12 patients and signing out to night float who carries three or four times that many, nobody's 3 a.m. labs get checked correctly.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-1169760909183316572007-01-25T13:35:00.000-08:002007-01-25T13:35:00.000-08:00If you want to send the house officers home at a c...If you want to send the house officers home at a certain time to meet ACGME time- on- job restrictions,it makes good operational sense to disabuse them of any archaic notion of a doctor being personally responsible for their patients.Otherwise they are liable to sneak back to the hospital to check on patients.Anonymousnoreply@blogger.com