Dumping ground

Medicine is often the service of last resort, who has to admit everybody: “The psychiatrist said to me ‘is there anyway we can find a reason to admit her to medicine?’”

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Stalwart Hospitalist
This has been happening more and more with the advent of duty hour limitations for residents, especially in the surgical disciplines…Medicine seems to be the admission service, with everyone else happy to revert to consultative status, even if the primary problem is surgical, or psychiatric, etc.
I will fault my Emergency Department colleagues to some degree as well, since they often will call the appropriate service first, but allow a junior resident (or intern!) on the service to “recommend” admission to medicine so that they can follow as a consult. By the time my team or I get the call, every other service has already refused to admit the patient.
It’s not that I don’t love doing H&Ps and discharge summaries (and, as a hospitalist, I’d wager that I manage transitions of care better than any other service), but sometimes this is just ridiculous.
Anonymous
My rule as a hospitalist is simple:
If I admit for you, you do my consults when I need them.
I’ll admit your 27 year old man with a broken humerus and nor medical problemds because you’re in the OR. I’ll admit the lady with CAD who has chest pain or the man with volume overload.
The catch is that when I call you at 3 AM and tell you that you’re taking my pt to the OR, the cath lab, or dialysis, you have to show up. You don’t have to agree with my plan, but you have to come in and assess the patient.
In my hospital, this system works really well. Maybe I just have a friendly group of consultants, but I think the mutual respect thing works very well.
It’s easier in non-academic settings.
jb
Query for anon 1109 above: As a general surgeon, I have done my share of 3 a.m. procedures on hospitalists’ patients. These folks have to be pretty bad off, or potentially that way without surgery, to get that service. I of course prefer to do my work between 7 a.m. and 7 p.m., but that does not always work out, and therefore I am often active after the regular hours of my “shift.” As a hospitalist, you are typically paid a salary to work your shift, and a colleague takes over your tasks for the next 12 hours after your shift ends. That is of course one of the great advantages of hospitalist work- relatively regular work hours with no call. I find it irritating, for want of a better term, that you find our positions equivalent- I’ll do my job for your patients only if you jump through hoops for me. When you admit the 3 a.m. patient, you are working your regular shift, for your regular hourly wage. When I’m active with your patient at 3 a.m., it’s often for no pay, and I feel like hell the next day. Yes I know that I asked (even prayed) for the opportunity to be able to provide this service, and I earn a lot more than you do typically, but still, your attitude is more than a little annoying. The docs I work with who work shifts (hospitalists and ER) are, or at least act, somewhat grateful when I come in to see their patients in the middle of the night. If they had attitudes like yours, I would be sorely tempted to admit my own patients, even at 3 a.m., and tell you to take a hike when your you call me to see the bellyache. Until you pass your American Board of Surgery Qualifying and Certifying exams (much more rigorous than the IM boards), you have no business telling me I’m taking your patient to the OR, or anywhere else. You can request an evaluation, but that’s it. Respect goes both ways- it can’t be demanded and it can’t be bought.

Dumping ground

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