No excuse

Am currently writing this at work. Am working the 11 pm to 7 am shift in the emergency room tonight and I am annoyed!

Have just seen a patient with chest pain and heart failure, who was just discharged from hospital 2 days ago. To cut a long story short, this patient definitely needs to be re-admitted due to his ongoing medical problems.

As the ED physician, we sign-out to the medical team receiving the patient to let them know about the background history of the patient, the preliminary diagnosis (I admit, sometimes our initial diagnosis can be wrong) and what we have done for the patient in the ED.

In my hospital, there are 2 teams admitting patients. One team is staffed by residents on-call, ie doctors in training (like me!) and the other team is staffed by locum doctors. Residents on-call work 30 hours overnight non-stop, while the locum doctors are on-call from 7 pm to 7 am only. Also, locum doctors are paid very lucratively for this work.

My patient was being admitted to the service staffed by the locum doctor, thus I dutifully called the locum doctor to sign-out my patient. Halfway through my presentation, she interrupts me and says, "FYI, I have capped for tonight, so if you have any more admissions, you will need to call the consultant himself from home to come in to admit the next patient."

(Each physician is limited in the number of admissions they can admit per shift, and the locum doctor is limited to 6 admissions. This was her 6th admission.)

I continued my sign-out and I could tell that she felt that this was an unnecessary admission. From my own previous experience as the medical physician receiving patients from the ED, I have personally been annoyed before as I felt that some patients did not need to be admitted. However, this patient definitely required admission as it would have been medical negligence to send him home.

I can understand the receiving doctor's frustration at having to admit another patient, but hey, you're being paid for your hours. Being paid very well too!

And there was absolutely no need for the FYI. Telling me that will not change my management for the next patient that comes through the ER door. If the next patient needs to be admitted, he/she will be admitted. Even if I have to call the consultant from home to do it. Threatening me with the FYI does not scare me in any way whatsoever.

It disappoints me that there are physicians working with this kjnd of attitude.