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:
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.
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