Specialist called me out...is this rude?

[Guest ERCat]

The other day I was in a patient's room letting him know he had a small bowel obstruction and that I had put a page out to a surgeon for him. The surgeon called me while I was in the room, so I answered and politely mouthed to the patient "This is the surgeon!" I sort of stepped aside in the corner of the room to have my brief conversation with him but stayed near the patient in case I needed to ask the patient questions on behalf of the surgeon. The surgeon asked me a few questions that I already knew the answers to, and then asked me another question I needed to run by the patient. I told him, "Let me ask!" then quickly put the phone to my waist, asked the patient the question, and relayed the message the surgeon. He asked if the patient was still tender and I pushed on his belly and then told the surgeon over the phone, "Yes." Later on, he reprimanded me and said that it was "bad form" that I talked to him in front of the patient. Most of the time I don't, but as he had so many questions I thought it was okay if I was standing by the patient. He seemed really pissed about it. To me it's a matter of efficiency...instead of hiding in my office and running back and forth between my office and the patient's room to ask them questions. Plus I don't want to be rude by keeping the surgeon on hold!!! I feel like I cannot win. I suppose in some cases I should be better prepared by anticipating questions the surgeon will ask, but sometimes I don't have a free second to get all my ducks in a row before the surgeon calls. Any thoughts on if this is truly rude or not?

[UGoLong]

Best not to be in the room when you take a call as you can’t be as open in your conversation. If you have to walk back in to get more data, then walk back in. It’s not so much about efficiency as it is having an open conversation with whomever you’re talking with on the phone.

It’s also important to finish your physical before calling a consult. Even in cardio, we always check for belly tenderness.


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[cinntsp]

1 hour ago, UGoLong said:

Best not to be in the room when you take a call as you can’t be as open in your conversation. 

Agreed.  I always find it frustrating when I call a nurse and talk about a patient only to have them say "ok, I'm in their room right now so I'll let them know."  A heads up is warranted.

[SedRate]

As a specialist, I have had this happen to me by a couple of ER providers in particular and mostly nurses. I personally don't mind because I know they're getting me the info I need, but I do agree with the other posters and would appreciate a heads up. Now, he most definitely could've handled his reaction differently.

[PickleRick]

No offense, because you can always get caught off guard by an oddball question but, something like "is the abdomen still tender?" is one of the most basic answers that you should have at the ready for a surgeon, and should never be answered with, "Let me check."  

My rule for consults is that I never talk about the patient in front of the patient, especially on the phone.  The average layperson has a poor grasp of medical lingo, and can easily misinterpret what you are saying, aside from the fact that he/she is only hearing one side of the conversation.

[PACali]

Really get to know your hospitalist and surgeon's stylehelps too. I would really try to get know them, understand their practice style within reasonable of course. That makes my job a lot easier. 

[MediMike]

Unless I am misreading the OP's initial post, it sounds like an exam was initially performed and then was being re-performed at that time by request of the surgeon.  I'm guessing that an abnormal physical exam led to the imaging which revealed the SBO.

Taking context from the post before replying in a condescending manner is important.  Even in critical care we do that.

[Guest ERCat]

19 hours ago, UGoLong said:

Best not to be in the room when you take a call as you can’t be as open in your conversation. If you have to walk back in to get more data, then walk back in. It’s not so much about efficiency as it is having an open conversation with whomever you’re talking with on the phone.

It’s also important to finish your physical before calling a consult. Even in cardio, we always check for belly tenderness.


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Of course I did my belly exam...this is the ER. I wouldn't have ordered a CT without doing a belly exam in the first place. This was an hour and a half later when everything came back. I was in the room talking to the patient about their results when the surgeon called me. He asked for a repeat belly exam, which I hadn't done because I had done my exam an hour and a half before and moved on to other things.

[Guest ERCat]

4 hours ago, MediMike said:

Unless I am misreading the OP's initial post, it sounds like an exam was initially performed and then was being re-performed at that time by request of the surgeon.  I'm guessing that an abnormal physical exam led to the imaging which revealed the SBO.

Taking context from the post before replying in a condescending manner is important.  Even in critical care we do that.

 

13 hours ago, PickleRick said:

No offense, because you can always get caught off guard by an oddball question but, something like "is the abdomen still tender?" is one of the most basic answers that you should have at the ready for a surgeon, and should never be answered with, "Let me check."  

My rule for consults is that I never talk about the patient in front of the patient, especially on the phone.  The average layperson has a poor grasp of medical lingo, and can easily misinterpret what you are saying, aside from the fact that he/she is only hearing one side of the conversation.

The abdomen was checked an hour and a half prior. During that hour and a half, I saw maybe five other new patients and talked to a few other specialists, followed up on labs, discharged old patients, etc. I did my initial examination and was in the room with the patient updating them on results and was about to reexamine them when the surgeon called...

[UGoLong]

Unless I am misreading the OP's initial post, it sounds like an exam was initially performed and then was being re-performed at that time by request of the surgeon.  I'm guessing that an abnormal physical exam led to the imaging which revealed the SBO.

Taking context from the post before replying in a condescending manner is important.  Even in critical care we do that.

 

Excuse me for not dedicating even more of my time to reading a stranger’s post before responding. I gave my opinion, which was not an attempt to be condescending.

 

I still stand with not taking calls about the patient in front of the patient.

 

 

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[PickleRick]

12 hours ago, MediMike said:

Unless I am misreading the OP's initial post, it sounds like an exam was initially performed and then was being re-performed at that time by request of the surgeon. 

Taking context from the post before replying in a condescending manner is important.  Even in critical care we do that.

7 hours ago, ERCat said:

.... This was an hour and a half later when everything came back....which I hadn't done because I had done my exam an hour and a half before and moved on to other things.

 

7 hours ago, ERCat said:

 

The abdomen was checked an hour and a half prior.... was in the room with the patient updating them on results and was about to reexamine them when the surgeon called...

Seriously, trying to be helpful.  

Get all results from investigative studies.  Go back into the room, and discuss your findings and concerns with the patient while performing an updated exam.  Ask the patient about any subjective changes in their condition.  Tell them you are going to call a consult with the surgeon, explaining the reasoning, and tell them you will let them know when that has occurred.  Have nurse grab a fresh set of vitals.  Place a call to the service.

Lastly, I am going to give the benefit of the doubt, and assume you at least popped your head in the patient's door over the hour and a half since first seeing them, to ask if everything is okay/any acute changes.  

[ventana]

I will provide a counter point

 

the specialist has NO RIGHT to tell you how to perform you job.  Period

 

If they do not want you to talk in front of the patient they need to tell you this

 

As the Doc's say "get out of my lane"

 

 

[GetMeOuttaThisMess]

1. I don’t think I was ever in an ED setting where a phone was available in the room to accept a front desk call transfer.

 

2. If I’m calling a surgeon due to a concern about a surgical abdomen I’m not waiting 1.5 hours to reassess the patient.

 

3. As long as the surgeon is not on speaker phone I’m not sure that I see the big deal. If cord allows, step outside the room and pull door closed.

 

4. Can we not stay focused on taking care of the PATIENT and not so much on keeping our panties out of our cracks (male and female, and referencing the surgeon)?

 

 

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[ohiovolffemtp]

Unfortunately, I can easily picture this situation: in my busiest ED we all carried Spectralink (i.e. cordless) phones, so all calls came directly to us.  Also, we were routinely managing 6-10 patients, so lots can happen between when a consultant was paged and when they called back.  Yes, a repeat abdominal exam is a very good idea, but even the repeat exam can be as old as the interval from when the page was put out and the consultant called back.  Not all of them call back quickly, even after multiple pages.

[medic25]

23 hours ago, GetMeOuttaThisMess said:

1. I don’t think I was ever in an ED setting where a phone was available in the room to accept a front desk call transfer.

 

2. If I’m calling a surgeon due to a concern about a surgical abdomen I’m not waiting 1.5 hours to reassess the patient.

Pretty common in our department as well.  We all carry hospital-issued iPhone's, so if the consultant is quick with their callback you are often in the room with the patient giving them an update. 

I don't think it's always a guaranteed that at patient will need another abdominal exam 90 minutes after the initial exam.  If the patient the patient had RLQ tenderness and has CT-documented appendicitis, they will still need to see the surgeon regardless of the repeat exam; in some situations it's just more likely to inflict more discomfort without adding much to the clinical management.

[GetMeOuttaThisMess]

Pretty common in our department as well.  We all carry hospital-issued iPhone's, so if the consultant is quick with their callback you are often in the room with the patient giving them an update. 

I don't think it's always a guaranteed that at patient will need another abdominal exam 90 minutes after the initial exam.  If the patient the patient had RLQ tenderness and has CT-documented appendicitis, they will still need to see the surgeon regardless of the repeat exam; in some situations it's just more likely to inflict more discomfort without adding much to the clinical management.

I have seen exceptions in a prior life. Best was a peds patient that had three people see kid before surgeon with variable presentation each time, normal CT, then the patient declared with a perf of the appy. IMO all possible surgery patients should be monitored with lesser interval reassessments. At this point, it doesn’t matter what I think.

[medic25]

8 minutes ago, GetMeOuttaThisMess said:

I have seen exceptions in a prior life. Best was a peds patient that had three people see kid before surgeon with variable presentation each time, normal CT, then the patient declared with a perf of the appy. IMO all possible surgery patients should be monitored with lesser interval reassessments. At this point, it doesn’t matter what I think.

Nah, it always matters what you think

I definitely don't want to downplay the importance of serial exams, especially in abdominal complaints; just saying that they may not always change much of the care plan.  In the patient with appendicitis on CT, they'll be getting antibiotics and a surgical consult regardless of what my repeat exam shows, then the surgeon will again push on their abdomen when they see them.  If I don't have a specific clinical question to address, it's not unreasonable to defer the repeat exam at times and spare the patient some additional discomfort.

[CAdamsPAC]

1 hour ago, medic25 said:

Pretty common in our department as well.  We all carry hospital-issued iPhone's, so if the consultant is quick with their callback you are often in the room with the patient giving them an update. 

I don't think it's always a guaranteed that at patient will need another abdominal exam 90 minutes after the initial exam.  If the patient the patient had RLQ tenderness and has CT-documented appendicitis, they will still need to see the surgeon regardless of the repeat exam; in some situations it's just more likely to inflict more discomfort without adding much to the clinical management.

Has anyone ever had a consultant surgeon not complain about SOMETHING you did or didn't do ?

[ventana]

18 hours ago, CAdamsPAC said:

Has anyone ever had a consultant surgeon not complain about SOMETHING you did or didn't do ?

BINGO

we have a winner!!

[Cideous]

1.  I agree, you should not be doing the phone consult with the patient present.  Bad form unless the patient was a personal friend or family member of the specialist.

2.  He didn't have to be such a dick about it.  He could of said, "Hey in the future could you not...."  But yeah, I've been called out by specialist docs many times because they are just having a bad day and they need someone to take it out on.