Okay, Grumpy fans. Put your books away and get out a #2 pencil. We're having another pop quiz. Mr. Knucklehead, please put away the issue of Boy's Life. We can all see you're hiding your mom's new Cosmo behind it.
Everyone ready? Good.
Question: You're a nurse at a major hospital. Your patient's white cell count (WBC) jumped from a horribly abnormal 44 yesterday to a frighteningly abnormal 79 this morning.
Do you call:
A. The hematologist treating the patient's bone marrow disorder.
B. The cardiologist following the patient's pacemaker.
C. The neurologist evaluating the patient's imbalance.
If you answered C, thank you for waking me up this morning. I greatly enjoyed your reasoning of "I called you because your name was the first one listed alphabetically."
Was it not possible to arrange a conference call among all three?
ReplyDeletedipshits are everywhere.
ReplyDelete;)
How about the nurse contacting the intern/resident looking after the patient who might be able to review the chart, examine the patient, arrange for appropriate further investigations and then contact an attending for a sensible discussion about doing what is best for the patient? Or am I grossly mistaken about the respective roles of doctors and nurses in secondary & tertiary care?
ReplyDeleteDon't even know what to say to that--well, no that's not true. I just probably shouldn't say it.
ReplyDeleteEverybody knows it's B, and only if B doesn't answer it's C of course! That nurse should brush up on her specialties.
ReplyDeleteOn call for this pateint with MS? Was it 20 of Neurelan or Neulasta was ordered?
ReplyDeleteJohn Woolman- I don't work at a teaching hospital.
ReplyDelete"I called you right after I called the aardvark."
ReplyDeleteHow about no one? I didn't really see a WBC jumping from one high level to another, while staying below critically high (100k) to be something that can't wait a few hours til they ALL come look at labs anyways.
ReplyDeleteWe had one CLL patient they let run at 400-600 for weeks.
Genius.
ReplyDeletePoor Dr Grumpy... you really need to keep a preposterous list of responses next to your phone for these late night calls:
ReplyDelete> Yes nurse, but not during pringled calf season. Then it is reverse alphabetical order. Sorry.
> Cyrillic or Roman alphabet?? You got it all wrong...
> Was that YOUR medical specialty-- the alphabet?
So I guess you need to change your name...
ReplyDeleteClassof65
Maybe they just wanted to hear your lilting voice. Who wouldn't?
ReplyDeleteCritical thinking fail. That's all I'll say.
ReplyDeleteTell her "in the Hebrew alphabet, Jehovah starts with an 'I'"
ReplyDelete-Flavius
Response to "Why did you call me" should always be "Because I thought the best doctor on the case should know about it".
ReplyDeleteUm, I'm a cook and even I know to call the A. Hemo-whatshisname.
ReplyDeleteDoes that get me a free consult for this nasty hang nail? Oh wait, that's not what you do either....
Change your name to Dr. Zymmer and the problem is solved.
ReplyDeleteAnd really, it IS Boy's Life.
Maybe she confused "white blood cells" with "white matter"
ReplyDeleteOr maybe she was just being an idiot...
Why didn't I see it earlier? Of course, that nurse must have a crush on you! Why aren't you flattered?
ReplyDeleteIn my (teaching) hospital we (the RNs) call the admitting team. Actually in both hospitals I work in, one in the ER and the other in a neurosurgery/trauma unit, we call the primary team. They are the only ones who write orders all the other teams simply consult and write recommendations.
ReplyDeleteSo...even though it would make sense to call the hematologist we'd call you if the patient was admitted to the neurology service as the primary.
Um, I'm gonna have to go with Christine-Megan here. I don't see any reason a doctor had to be awakened for this.
ReplyDeleteCritical thinking skills are in very short supply these days.
Wouldn't the haematologist be the one to call?
ReplyDeleteOn behalf of the nurses with more than two brain cells, please accept our apology.
ReplyDeleteMay I second that apology?
ReplyDeleteReally, some of us nurses can think...I promise!
Pattie, RN
Pattie and ERRN4U- I know. The majority of you guys totally ROCK!
ReplyDeleteBut good nurses, like normal patients, generally aren't funny enough to write about here.
Leukocytes look a lot like nervous cells! No, wait, they don't! Let's call a NERVE DOCTOR anyway. He will know better than a BLOOD DOCTOR for sure! Yeah.
ReplyDeleteYour profession must pay well to put up with so much crap. How long til you can retire, or will you?
ReplyDeleteAnd you wonder why Lab has little use for most RN's.
ReplyDeleteShit rolls downhill and some poor Tech will get reamed by the Haematologist for not calling him/her with the result directly.
I'm with Christine-Meagan. That's not a change worthy of a wake up call at all.
ReplyDeleteMaybe she called the neurologist because trying to figure out who to call gave her a migraine.
Maybe the GP, because it just might be strep throat or the appendix. Ya never know.
ReplyDeleteIt's things like this that make me feel braver about the possibility of returning to nursing. I may have some deficits secondary to having Cushing's Disease... but I'm not stupid!
ReplyDeleteThanks for the encouragement Dr. G!