Thursday, July 17, 2008

If I Should Fall To Rise No More...

Another one of us runs aground; a fellow blogger, whose work I try to follow closely has been rumbled. It's always a risk, if one tries to keep this sort of thing secret. For those of us who blog about events that might have involved other people have to worry about libel, and, for the medical blogger, issues of confidentiality.

There have been a few relatively high profile cases, and I think it's why most, if not all of us write hypothetical, or composite cases. I occasionally mention real people, and talk about patients, but I remind you all once again that the details of the cases are representative only.

Except of course when I saw that Patricia Hewitt is a bitch. That's true.


Anyway, I'm not sure what fate awaits our fellow blogger. People I work with know I blog, but have chosen not to take me to task over it; I'm fairly sure my writing is cast iron enough. I guess it's probably good advice not to describe colleagues in a derogatory way unless you don't care if they read it.

Which brings me nicely onto another rant about my surgical colleagues. I apologise for the overly whiny nature of my recent posts. But I need to vent. Colossus, God love him, had to endure my initial autologous autosplenectomy on my way out this eve. Now I choose to share it with y'all. I'm trying to vent enough that I won't chew La Belle Fille's ear off.

In defence of my colleagues, I'm sure they are all excellent surgeons; and, I have no doubt, that if you quizzed them about me, there would be plenty with which they could find fault. It is easy to paint a picture that seems to make your point of view the reasonable one. What follows is thus not an objective telling.

It's my blog, however.

Again, this morning, the facial surgeon was confronted with a patient with diabetes. The mere presence of this rare and exotic condition seems to have struck fear into their hearts, and they duly requested a medical review. When they were directed in the direction of the phone, and provided with the bleep number, the better to discuss the case themselves, it was decided that, perhaps, discussion with the duty magicians was not necessary, but would the nurses ask me to look over the results.

When I was a wee fungus, we always directed our questions up the chain before going sideways. I'm not sure when that stopped.

The patient managed to give their own insulin, as they do every day, without sustaining horrific mishap, and got to outpatients in one piece.

This afternoon, I spent a joyous time talking on the phone to several of my colleagues; my conundrum concerned a young woman, obviously shocked, with obviously intra-abdominal mischief. The cause was not immediate apparent, but we were leaning toward an abdominal aneurysm. The General Surgeon was sure it was an aneurysm, and wanted a scan. He was reluctant to see, or touch the patient. The Vascular Surgeon was equally sure it was not an aneurysm, and wanted a scan. He was equally reluctant to see, or touch the patient. I eventually managed to get them together, but this did nothing to disabuse me of the idea I have that we are increasingly substituting 'a scan' for examination of the patient.

Interestingly, despite all the assurances to the contrary I received from the Vascular boys that an aneurysm was not the problem, the scan suggested otherwise. I saw the vascular boys after the scan; no comment passed between us about how interesting the results of the scan were; I suppose they were rushing too quickly to theatre to talk.

Lastly, and what eventually kept me at work two hours after I should have left, I spent some considerable time with a young patient. They have a complex psychological disorder, which results in frequent visits to the ED. Much time has been devoted to the investigation of their symptoms, and they frequently take their own discharge. Tonight was no exception, but what nearly pushed me over the edge was when the patient was returned, against their will, by two well meaning non-clinical staff. Despite my best efforts, I surely felt that they considered me derelict in my duty, as our patient did not look well. The idea of capacity, and right to refuse treatment did not seem to compute. We eventually parted company, agreeing to differ, as my well meaning colleagues were not willing to wrestle to patient into the Department, not willing to section someone they know nothing about. Which is just as well, since merely behaving in a way you don't approve of is not grounds for declaring someone mentally incompetent.

I suspect I may hear more about this one.

I'll try to be less sanctimonious tomorrow; I'm sure it doesn't become me...


RossH71521 said...

what happened to BBP????? Why is it invited readers only, he's not going the same way as mousie is he? :-(

Calavera said...

Oh no, another blogger is rumbled. You know, it pisses me off that some people just make it their full-time obsession to gather information to track down someone's identity online. It's really sad, a total waste of time, and usually the intent is malicious. I hope your fried is alright.

...And what do you mean that these teams wanted a scan but that they didn't want to see the patient? As in, they didn't want to go to the patient and take a history and do a clinical exam? Why?

DrShroom said...

Didn't know about BBP; the climate of fear?
The prevailing attitude I encounter from surgical teams is about time saving; so where the diagnosis remains in dobt, they don't wann get involved if they don't have to; the scan provides the diagnosis, and obviates at least one of them from the need to come to the ED.

Faith Walker said...

BBP is still ok- just invited readers only.

RIP The Oracle.