A couple of weeks ago, I encountered an interesting case referred by my medical colleagues for review. The patient initially presented to a private hospital for fainting spells. He was seen by the cardiology service and was subsequently referred to a government funded hospital because of financial constraint.
The on-call physician saw the case at 4pm and wrote in the notes: For urgent cardio referral cm.
The 'coming morning' was in fact on a Saturday. My medical officer received this referral early in the morning and narrated the case to me. We went to see the patient together and I must say, I was amazed at the subtle signs of uncertainty displayed by my medical colleagues.
The patient was diagnosed as having non-ischaemic dilated cardiomyopathy with an EF of 20%. The private cardiologist's assessment was that this patient might have recurrent ventricular tachyarrhythmia hence causing recurrent syncopes. They did an MRI to rule out an intracranial pathology. The MRI showed an incidental benign cyst which could not have accounted for the symptoms. But because of the 'obvious' finding on brain MR, the patient was 'siphoned' to the neurology service.
The physician in-charge of the neurology ward was almost certain that the incidental benign cyst would not have accounted for a more serious problem. On the other hand, it was quite clear that she hesitated on the 'urgency' of referral to the cardiology.
It was half past four in the afternoon, I must admit that it is a 'semi-taboo' to make non-urgent referrals at these hours. People are packing up, preparing to take rest after a long day work. Any non-urgent referrals at this time are pretty much unwelcomed.
Nevertheless, URGENT referrals must be made instantly, regardless of the time of the day!
The very fact that she chose to write: Urgent referral coming morning, simply reflected the uncertainty of urgency in that sense.
Well, to me it's simple. We all will become uncertain when confronted with problems out of our specialties. The solution is simple. We walk to the nearest phone, pick up the dialer and ring up the specialty in regards. One call would clear out the uncertainty.
Unless, of course, ego and pride set in to hinder that walking up to the phone, picking up the dialer and engaging in a consultation.
Unfortunately it happens all too often in the service, sad to say.
The on-call physician saw the case at 4pm and wrote in the notes: For urgent cardio referral cm.
The 'coming morning' was in fact on a Saturday. My medical officer received this referral early in the morning and narrated the case to me. We went to see the patient together and I must say, I was amazed at the subtle signs of uncertainty displayed by my medical colleagues.
The patient was diagnosed as having non-ischaemic dilated cardiomyopathy with an EF of 20%. The private cardiologist's assessment was that this patient might have recurrent ventricular tachyarrhythmia hence causing recurrent syncopes. They did an MRI to rule out an intracranial pathology. The MRI showed an incidental benign cyst which could not have accounted for the symptoms. But because of the 'obvious' finding on brain MR, the patient was 'siphoned' to the neurology service.
The physician in-charge of the neurology ward was almost certain that the incidental benign cyst would not have accounted for a more serious problem. On the other hand, it was quite clear that she hesitated on the 'urgency' of referral to the cardiology.
It was half past four in the afternoon, I must admit that it is a 'semi-taboo' to make non-urgent referrals at these hours. People are packing up, preparing to take rest after a long day work. Any non-urgent referrals at this time are pretty much unwelcomed.
Nevertheless, URGENT referrals must be made instantly, regardless of the time of the day!
The very fact that she chose to write: Urgent referral coming morning, simply reflected the uncertainty of urgency in that sense.
Well, to me it's simple. We all will become uncertain when confronted with problems out of our specialties. The solution is simple. We walk to the nearest phone, pick up the dialer and ring up the specialty in regards. One call would clear out the uncertainty.
Unless, of course, ego and pride set in to hinder that walking up to the phone, picking up the dialer and engaging in a consultation.
Unfortunately it happens all too often in the service, sad to say.
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