Saturday, February 13, 2010

Rode Into Nazereth...

I have had to admit, or at least refer for admission, a number of patients recently in a genuine display of Cover Your Ass medicine. I hate practicing CYA medicine, and yet it seems to form an increasing part of my practice. Evidence Based Ass Covering.

Increasing seniority brings with it a diminishing ability to be wrong. Mistakes are allowed, almost expected of junior staff, and as long as they aren't disastrous... well, you know what I mean.

However, the ever increasing pressure of the 4 Hour target (All Hail) gives me less and less time to think about what's wrong with, and what's best for my patients.

And so, I end up referring those folks who just aren't right. I am losing faith in my clinical acumen, because I know I can't always be right, and I can't afford to be wrong.

Of late I have seen a number of folks who present with odd neurology - non-anatomical numbness, or transient, fleeting symptoms, or symptoms that just don't match the signs.

And they are almost invariably drunk. And will deny this.

I am sure they have no pathology, but I can't send someone home who is telling me the whole right side of their body is numb. Can I?

1 comment:

Jeannette said...

It gave me a giggle to to hear of CYA medicine, v. clever. That is basically what it has become. I am sure an "official scorecard" is right in order as well.