Here at LGH, the locums appear to be considered as the "turn the crank" guys - see a lot of patients and move the meat (though that is in much smaller numbers than what we're used to. Rarely do you see anyone juggling more than 3 or 4 patients at a time. I haven't had a chance to go through the logbook to see just how many are being seen per shift, per senior doctor. But, if we see about 100-120 per day and rotate through 5 registrars and 3 consultants - that's about what it feels like - 10-15 per shift max - with some of those being seen by interns and junior residents with limited if any input from the senior staff.)
Often, the sicker patients are handled solely by a consultant or Registrar while the interns continue to plod through the less acute and serious stuff. Fortunately, the whole program is loose enough (gross understatement - loose, in the sense of totally without pattern) that I'm able to pick up a sick patient and then grab an intern to "take over" from me - and the intern gets to be primarily responsible with close oversight. They seem to like the chance to see a sick patient, get close supervision and teaching, and maybe some procedures. And, since documentation is loose - but onerous, it saves me a lot of paperwork time. Seems like a good tradeoff.
A little different style than some of the attendings, I gather.
Another sidelight: we get really annoyed at home about the "safety" stuff: Pyxis, double and triple checking, etc. Apparently, there is some virtue to all that. I started an order sheet (on a hyperkalemic guy with a cardiomyopathy who had a baseline wide QRS that was even wider) and a nurse stuck a sticker on it for me - but for the guy 1 bed over. Fortunately the guy in the next bed over had a high normal K+, though he didn't much like the taste of the Kayexelate (and, perhaps fortunately, there's a recent article that suggests that Kayexelate doesn't actually work). Anyway, all the good stuff - calcium, bicarb, albuterol, insulin - got to the correct patient, and he eventually got some Kayexelate also.
Nurses had not apparently given Calcium Gluconate "neat" before - another new Aussie term, apparently brought to the hospital from the Pub.
Gotta figure out the surgical consult pattern: resident called surg registrar to see a lady pretty sick with clinically perforated diverticulitis (fever to 39.6, tachycardia, and pretty extensive LIF (Left Iliac Fossa - our LLQ) peritoneal findings. Surg didn't want to see it - medicine should handle it. Medicine didn't know if they should do a CT. But, the ED staff gets their ass kicked if they order the CT and find something surgical and then call surgery with the (now) clearly surgical diagnosis. It's a real catch-22 deal. I've gotten to know most of the surgical registrars well enough that it's less of an issue for me, but I see it continue happening to the more junior folks.
Off to work. My best to all in the states.
I still love that bedside blood gas machine. So much information, so quickly - as long as the nursing staff notices the order for it.
Oh, that reminds me - there is no "flagging" system for orders - you just stick med orders and lab orders in with all the other paperwork and hope that someone sees them, or wander around the wilderness until you find a nurse to tell verbally that orders are ready. There is no ordering system for non-medication nursing tasks or ECG's - all verbal (give some Kayexelate to one of the guys in obs - any one will do). Hand written imaging requests - you personally walk over to radiology and find a tech to hand the paperwork to!!! 10 patients per shift - it's about right.
No comments:
Post a Comment