Pt. in persistent AF c RVR. Had two doses of Diltiazem, was on a Dilt gtt, got 0.5 of Dig. Slowed down for a little while after each med, but after a bit was back to his old tricks in the 140s-150s. Totally asymptomatic, but yes I do understand the importance of rate control despite lack of symptoms. In fact, I explained this concept to the patient when he asked why he couldn't just go home and live in a rapid rate, since he didn't feel anything.
Hospitalist comes in, sees rate on monitor, says to me "So he's at a rapid rate and we're not doing anything for him?".
I dunno, maybe look at the chart. Maybe talk to the ER doc. Maybe ask me the question in a different way, in a different tone of voice?
Totally unnecessary to come in here and flip me attitude, like it's my fault the guy is refractory to everything we've done.
I know in hindsight that I should have calmly and methodically reviewed the chart with the hospitalist and told her everything I had done so far and what the results had been, but I was pretty taken aback by her attitude, had stayed an hour late because things were so busy, and really felt attacked. I'll do better next time.
It's like nails on a blackboard. So often, I'd ask the patient "Did you ask the doctor about that while they were in here?", which the vast majority of the time, they hadn't. They'd only assumed.
In my experience, I don't think it's an assumption, or oversight, at all ... it's a game, played by experienced ED players.
Yes, you're right, often it is that way. Sometimes, though, it is an assumption and the person is just so self centered that they think nothing of wasting other people's time. It's still rude behavior either way you slice it.
Reminds me of an incident I had a few weeks ago while sending a patient upstairs. College age girl with SOB x5 days. Chest CT reveals multiple PEs... described by the radiologist as "significant" clot burden. As I'm waiting for her bed to be ready, I give her the heparin bolus & start the drip, as well as do a lot of teaching.
Talk to the nurse that will be getting her and when I ask her if she as any questions, she says in this really snotty tone, "well it doesn't look like we've DONE ANYTHING for her." To which I ask her if she means have we started her heparin & bolused her? She says yes. I respond as politely as I can, that yes, in fact I had done all of that and if she had looked at the MAR, she would have seen that.
Gah.
Had to comment, that was a great thing for her to say in front of the patient, that "we haven't done anything for her" comment, especially since she didn't bother to check what had actually been done. Patients then go and tell everyone that they know, "I went to ABC Hospital with my lungs full of potentially deadly blood clots and they didn't do ANYTHING FOR ME until after I had been there for hours! I could have died!" Sheesh...
Ahvegas
1 Article; 20 Posts
That's par for the course some days-it's strange how professions sometimes don't assume EVERYONE is working as a professional, only them?