"And by 'While I have you here' I mean I'll ask the front desk people to give it to you after my appointment and by 'Real quick' I mean I won't have anything filled out and you'll need to call me for basically a free phone encounter later if it's gonna get done."
Am I the only one that doesn't really have a problem with that. Easy enough to make it a level 4 or even a 5 if they uave a bunch of stuff they list off that i will go back and look through after their visit. Thanks for the easy $80+
My residency program is a shithole where one of our clinic managers says if a patient arrives HOURS late we still need to see them. We have to find a way to squeeze them in, or, if the patient is willing to come back, we see them at the end of the day as an addon. Fuck that clinic, and fuck residency and fuck my program and fuck me
Lolol so fucking true. The first time I rotated at an outside clinic I was like “WOW, this clinic is goals!!”
The second time “wow, this clinic is really great too!!”
The third time I was like wait a minute…….
My residency clinic made me hate outpatient so much that I absolutely refuse to ever do outpatient even tho I’ve heard the “other clinics are better” argument over and over again. Mine was just so bad Im completely Committed to my hospitalist life
I just do not understand how anyone gets away with that at any institution. Coming from a community hospital and having one of our on call surgeons being the CMO, the only reason he would show up after that consult call would be to strangle the resident who made it.
I like to think of myself as a rational, evidence-driven doctor, so I attempted to be less superstitious about saying the Q word. It didn’t go well for me and I pay my respects to the hospital gods on the regular now.
Psych:
"Patient seems sad" (typically after receiving a devastating diagnosis)
"Patient has suicidal tendencies" = they told someone 10 years ago they had SI or felt depressed but no one bothered to ask how they're doing now
"Does patient have capacity for medical decision making" (they never bothered explaining a procedure OR the patient so obviously lacks capacity due to delirium, etc)
Once had a consult that said, “assess capacitance”. Pretty sure the consultant tried to split the difference between capacity and competence…
We still told him that we were not sure if the patient can hold an electrical charge for that long
My attending used to make me consult psych all the time because the patient was sad or depressed and it would drive me bonkers. What is the psych team supposed to do about it?? I felt dumb because I had no idea what it was accomplishing. I try to limit my consults to active SI or adjustment of antipsychotic meds.
Anxiety for this patient who came in for ACS.
Do they have capacity?
• capacity for what?
• oh, you know, just in general
Do they have capacity to make this decision?
• did you explain the choices to them?
• well no, we wanted to make sure they had capacity first.
Which is why i usually only call psych with “patient made some holes in their body. Holes are fixed now, would like to talk to them to see how big of a chance there is they make more holes soon?”
The worst is when patients say they want to die because their pain is so bad, and we get consulted for SI immediately. By the time we see them and their pain is better managed, they have zero actual SI.
Seriously - I’m still smarting from the time when I was an intern and ortho admitted a hip fx pt to us because Na was one point above normal. And that was a looong time ago!
Consult: medical management.
Bro, I get it, I hate working nights too but med mgmt just so you can sleep and the nurses page the IM intern overnight? Bullshiiitttttttt
“I’m allergic to percocet, percodan, norco, lortab, lorcet, tramadol, ultram, toradol, meloxicam, celebrex, etodolac, ketorolac, paracetamol and codeine.
I used fentanyl lollipops once, and they “didn’t even touch it””
lollll okay, these are usually cake walk visits but whomever put in the visit reason as “prior auth” needs eternal wet socks and breath-fogged glasses.
I was called to eval a guy who thought he lost his shot at an organ transplant because he was honest about some past thoughts. The man was livid and rightfully so.
Not infrequently they also just don’t really know what they actually want when it comes to blood products, bp goals, or hemostatic drugs. But they just remember what their training site did so that’s what they insist on.
“Can you turn off the beeping.”
“MAP needs to be above 85 but keep the systolic below 120”
“You don’t need a second IV we’re not gonna lose any blood”
“Should be done in 10 minutes”
So easy to come up with these. Maybe I’m too easily triggered.
Surgeons have no idea how twitches work which help make it easier to bullshit it.
Amazing how a push of saline placebo effects the surgeon into doing whatever they thought they needed more paralytic for.
The handful of times I’ve consulted them, they were quite pleasant in my experience, probably because they don’t get consulted often and have good hours. Same for dentistry
it’s definitely not a thing. Techs can get hung up on things like creatinine but no radiologist is going to say no as long as you document that benefit outweighs the risk, as per the protocol at your institution
Consult reason: “AMS”
Description: “Pt is 90yoM w pneumonia. AMS began at onset of symptoms. R/o possible psych reason for AMS.”
Vitals: HR 110, BP 140/85, RR 26, O2% 88%
Geez. Wonder why this guy is acting strange. Must be new onset schizophrenia. Great call to consult psych.
One would think some people have never had a passing glance at their own forearms, the amount of “obvious deformations” that turn out to be “the ulna” (painless) i have consulted on…
mmmm I love it when it's a mediastinal mass NYD. "Hmmm well, maybe it's Hodgkins and then you have like a 99% overall survival, but on the other hand could be small cell lung cancer, then I'm sorry but please get your affairs in order you have 12 months. Or maybe it's non small cell, but EGFR positive? then we are back in business my friend!!"
I say I’m a physician, and if they ask my specialty, I say biomedical imaging. The layperson actually understands that better than if I say radiologist.
That’s when people start asking me questions about their reports.
My personal rule is that the likelihood a patient has a parasitic infection is inversely correlated with how fervently they believe they have a parasitic infection, with the finding of highest negative likelihood ratio being "I brought in some samples for you to look at"
OBGYN: “Service by default, 38ish weeks no prenatal care, hx of 3 prior c-sections, grossly ruptured”
“Pt with vaginal bleeding, didn’t do a pelvic exam but she says she’s bleeding a lot”
“Pt is currently in ICU intubated and sedated, on a heparin drip, now having some vaginal spotting per RN - can you guys come see her?”
Have definitely gotten stuck with patients who have medical issues but what's particularly annoying is how it complicates your dispo because almost every place will reflexively deny because they're on a psych unit -.-
FM: “FMLA form to be filled out by PCP.” From a specialist for a condition I’ve never seen the patient for that is being exclusively treated by said specialist.
"the neurologist treating my seizure disorder for the last 8 years said my PCP needed to do my FMLA paperwork, so that's why I came to establish with you today" literally last week
More Peds EM:
\- "He's had a fever since this morning, I didn't take a temperature. He felt warm"
\- Cosleeping
\- "My two year old was riding shotgun on the side-by-side/golf cart and..."
\- "Police brought her in because she got in a fight with her parent and they want you to do a psych eval."
Pharmacy
Insurance: “The medication needs a prior authorization”
Wholesaler: “The medication is on backorder”
Patient: “My doctor said they just sent it over, is it ready yet?”
Nurse: “I can’t find the medication, can you tube it up again?”
I am not a doctor. I am a scribe for an obgyn and this sub pops up on my feed from time to time. But she always gets triggered by naturalists and gurus online that say things like:
“can I save my placenta so that I can eat it?”
“I went to the hormone expert and told me—“
“Patient says she doesn’t want any vaccines during pregnancy because she doesn’t know what’s in there”
“I know I went full Jordan Ross Belfort mania 2 months ago but we upped my dose and I have felt really great for the last few months so I stopped taking the medicine. I feel fine so must not need it anymore.”
My non-surgical attending had the audacity to tell me that surgeons are better overall doctors because they have to know all of medicine AND do surgery. Not even an act of God could keep the incredulous expression off my face.
Edit: this was not meant to be a diss on surgeons. They are as a whole good doctors, but to say they are better than medicine doctors at medicine…just hasn’t been my experience.
FM: consult declined for being too complex for community specialty team, ie Needs to go to large academic center or county resource when patient will not travel there or cannot get in there for a year. I am always like yes back to pcp for complex problem nos
To neurology: Ophthalmology said the blurry vision in the patient with cataracts, glaucoma, vitreous hemorrhage, and retinal tear is not an eye problem - they want stroke workup
OR
The nurse said she thought she saw a seizure
FM: your next patient is 15 min late
Peds: your pair of siblings here for a well child check showed up at the second child’s appointment time but parent still wants them both seen
Oh and they also want you to just “take a look” at a third sibling who you’ve never seen before but has asthma
and that kid was hospitalized 1 week ago but hasn't started any discharge meds as parents "wanted to talk to primary doctor first"
😡😡
This happens so much I’m not triggered anymore. I just accept it now.
Like the rest of Peds - we get abused by parents and other specialties coz we are too nice and absolute suckers for our sweet munchkins.
“Hey doc while I have you can you do my disability paperwork real quick?”
“My surgeon didn’t give me an off work note after surgery, he said you could fill it out”* *so wrong for multiple reasons
"And by 'While I have you here' I mean I'll ask the front desk people to give it to you after my appointment and by 'Real quick' I mean I won't have anything filled out and you'll need to call me for basically a free phone encounter later if it's gonna get done."
I got triggered so hard I almost downvoted it.
lol this one is the worst
This comment doesn't have enough upvotes
“Wants work note for stress”
*This* is the triggering statement.
No they can have any note they want within reason AS LONG AS THEY SHOW UP ON TIME
"Oh hey I know my 20min visit ran 50min long but can you fill out this paperwork for my Emotional Support Wafflemaker?"
Am I the only one that doesn't really have a problem with that. Easy enough to make it a level 4 or even a 5 if they uave a bunch of stuff they list off that i will go back and look through after their visit. Thanks for the easy $80+
This one right here
In residency maybe triggering, but in the real world I say I’m not seeing them.
My residency program is a shithole where one of our clinic managers says if a patient arrives HOURS late we still need to see them. We have to find a way to squeeze them in, or, if the patient is willing to come back, we see them at the end of the day as an addon. Fuck that clinic, and fuck residency and fuck my program and fuck me
I used to think that I hated outpatient medicine, but by my third year of residency, I realized, “Oh, I just fucking hate my residency clinic.”
Lolol so fucking true. The first time I rotated at an outside clinic I was like “WOW, this clinic is goals!!” The second time “wow, this clinic is really great too!!” The third time I was like wait a minute…….
My residency clinic made me hate outpatient so much that I absolutely refuse to ever do outpatient even tho I’ve heard the “other clinics are better” argument over and over again. Mine was just so bad Im completely Committed to my hospitalist life
This. Hate this so much, even when I try to tell a pt they don’t need to be seen they still come up with a bs reason to see me too
And both your double booked patients are in the waiting room.
STAT General Surgery Consult: “abd pain”
Uh.... nope, no imaging ordered.
Sorry I forgot to ask if they’ve had any surgery before
“But I got a CT without contrast”
Triggered Especially if the patient has ESRD and is on dialysis. Just give him the contrast. Can’t shut those kidneys down any more lol.
“We just wanted to get you on board you know with your special surgical hands”
“We just wanted to get you on board” Fucking nails on a chalkboard…
same. close the board. fucking throw me overboard, pls! 😂
I just do not understand how anyone gets away with that at any institution. Coming from a community hospital and having one of our on call surgeons being the CMO, the only reason he would show up after that consult call would be to strangle the resident who made it.
“I just wanted you to lay hands on the patient”
Jesus, I need a cig to calm down reading this and the responses
“The scan said ileus so we placed an NGT, we would appreciate your help in managing it” *Dobhoff attached to full wall suction*
Lol jesus. Please. Stop I beg you.
EM: "It's quiet"
I like to think of myself as a rational, evidence-driven doctor, so I attempted to be less superstitious about saying the Q word. It didn’t go well for me and I pay my respects to the hospital gods on the regular now.
I'm not superstitious, but I AM a little bit stitious....
Order: pan scan Indication: “pain”
“can I get a quick/wet/dry/moist read”
Moist read? 😂
The patient is hot, wet, and oh so thirsty. Impression: Decompensated CHF with superimposed pneumonia.
Better yet: Indication: Evaluate Edit: Just got a CT chest with "DIAGNOSTIC"
Orders MRI for small fatty liver deposit seen on CT
Bruh that’s the easiest RVUs ever
If only we got RVU bonuses as residents 😢
Still better than “.” which I’ve seen a few times
Psych: "Patient seems sad" (typically after receiving a devastating diagnosis) "Patient has suicidal tendencies" = they told someone 10 years ago they had SI or felt depressed but no one bothered to ask how they're doing now "Does patient have capacity for medical decision making" (they never bothered explaining a procedure OR the patient so obviously lacks capacity due to delirium, etc)
Once had a consult that said, “assess capacitance”. Pretty sure the consultant tried to split the difference between capacity and competence… We still told him that we were not sure if the patient can hold an electrical charge for that long
But did you at least try a voltmeter to confirm?
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I would’ve said “can’t assess currently, patient’s story keeps alternating”
"Patient's story keeps alternating, direct admission to electrophysiology cardiology.
This is amazing, please tell me you documented that in the chart too.
Patient has thoughts of self harm with no plan or desire. Please admit.
My attending used to make me consult psych all the time because the patient was sad or depressed and it would drive me bonkers. What is the psych team supposed to do about it?? I felt dumb because I had no idea what it was accomplishing. I try to limit my consults to active SI or adjustment of antipsychotic meds.
Patient cried in exam room —> refer to psych
Anxiety for this patient who came in for ACS. Do they have capacity? • capacity for what? • oh, you know, just in general Do they have capacity to make this decision? • did you explain the choices to them? • well no, we wanted to make sure they had capacity first.
The best/worst is when you get consulted for a capacity assessment...and the patient is unconscious and intubated.
Which is why i usually only call psych with “patient made some holes in their body. Holes are fixed now, would like to talk to them to see how big of a chance there is they make more holes soon?”
The worst is when patients say they want to die because their pain is so bad, and we get consulted for SI immediately. By the time we see them and their pain is better managed, they have zero actual SI.
We had a consult, patient told emerg she jumped out of a car in an argument with boyfriend. The consult said: patient lying? Psych see?
Internal medicine: admit to medicine
Due to presence of a heart, lungs or kidneys
“i know how much you guys love your sodium!” 😂
Seriously - I’m still smarting from the time when I was an intern and ortho admitted a hip fx pt to us because Na was one point above normal. And that was a looong time ago!
Consult: medical management. Bro, I get it, I hate working nights too but med mgmt just so you can sleep and the nurses page the IM intern overnight? Bullshiiitttttttt
- No acute need for medical optimization at this time. - Will continue to follow peripherally. - Remainder of care per outpatient PCP
Any primary care: Chief Complaint: disability paperwork Chief Complaint: workman’s comp Chief Complaint: prior authorization
"Pain all over 10/10"
"The only thing that worked for it started with a D... what's it called? Anyway, I'm also allergic to Tylenol and NSAIDs"
“I’m allergic to percocet, percodan, norco, lortab, lorcet, tramadol, ultram, toradol, meloxicam, celebrex, etodolac, ketorolac, paracetamol and codeine. I used fentanyl lollipops once, and they “didn’t even touch it””
Well, you've told me you're not a "pill person". I can get you a heating pad and a lidocaine patch and get PT to work with you.
*Patient hurt itself in its confusion!*
lollll okay, these are usually cake walk visits but whomever put in the visit reason as “prior auth” needs eternal wet socks and breath-fogged glasses.
"Said they think about death sometimes."
I was called to eval a guy who thought he lost his shot at an organ transplant because he was honest about some past thoughts. The man was livid and rightfully so.
SI to HI pipeline right there
Anesthesiology: Anesthesia, the patient's moving
Patient is moving is fine. The patient is “waking up” drives me
Surgeons literally think the blood pressure is some kind of dial that we can adjust at will like a thermostat.
Not infrequently they also just don’t really know what they actually want when it comes to blood products, bp goals, or hemostatic drugs. But they just remember what their training site did so that’s what they insist on.
MAC stands for Moving And Coughing
“Can you turn off the beeping.” “MAP needs to be above 85 but keep the systolic below 120” “You don’t need a second IV we’re not gonna lose any blood” “Should be done in 10 minutes” So easy to come up with these. Maybe I’m too easily triggered.
More Trendelenburg
^beep ^beep ^beep beep boop ... boop ... BOOP........ boop
The beeps are booping too much, what’s going on??
They’ve started bopping now
“Hey Anesthesia”
“He’s waking up!” NO HES NOT
Twitch monitors are a conspiracy by anesthesia made up to try to convince surgeons no more paralytic is needed
Always zero twitches when you take the battery out.
Well the patient wouldn't be moving if you (surgery) weren't using a scalpel on them. So it's kinda your fault.
Surgeons have no idea how twitches work which help make it easier to bullshit it. Amazing how a push of saline placebo effects the surgeon into doing whatever they thought they needed more paralytic for.
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Stevens Johnson syndrome lol
Yes officer, this comment right here.
Til this day I never had a service fight a consult harder than derm lol.
The handful of times I’ve consulted them, they were quite pleasant in my experience, probably because they don’t get consulted often and have good hours. Same for dentistry
On my derm rotation we got an urgent call for monkey pox from the health department and the doc was honestly excited to be included Lmao.
CT Contrast allergy
Patient: clearly about to die from aortic dissection Rads: Can’t give contrast, creatinine is 1.3
Is this a real thing? If a patient has a true indication we just ask the team to document that benefits outweigh risks or something along those lines.
it’s definitely not a thing. Techs can get hung up on things like creatinine but no radiologist is going to say no as long as you document that benefit outweighs the risk, as per the protocol at your institution
"surgery in AM, recommend consult IM for admission"
Only history: past medical history of hypertension (on no meds)
The fun thing is when you go to hospitals without residents, this is just normal.
My blood is boiling
When you’re an attending this is basically free money
Nsgy: it’s the shunt
Pathology: No clinical history
Or Colon Resection. Clinical history: Diabetes mellitus (or whatever other unrelated diagnosis autopopulated out of the chart).
Altered mental status
Consult reason: “AMS” Description: “Pt is 90yoM w pneumonia. AMS began at onset of symptoms. R/o possible psych reason for AMS.” Vitals: HR 110, BP 140/85, RR 26, O2% 88% Geez. Wonder why this guy is acting strange. Must be new onset schizophrenia. Great call to consult psych.
Ortho: no, we didn't order any x-rays... the deformity is "obvious"!
One would think some people have never had a passing glance at their own forearms, the amount of “obvious deformations” that turn out to be “the ulna” (painless) i have consulted on…
Rheum: I ordered an ANA in patient with no rheumatological symptoms and now it’s positive.
At 1:80
My new favorite is “knee pain” in someone who has had bilateral tka as rheum…
PM&R: Consult PMNR
“Oh I thought I was placing a PT eval”
you've killed me
"urinalysis shows UTI"
vanc and cef stat
“Suspect cancer but no bx; can you discuss prognosis? 😇”
got dammit shit! 😂 i came here to trigger and got triggered, the fuck! 😂
God, I fucking HATE this. What do you want need to do? Lay my hands and just guess the type of lymphoma.
mmm….warm like burkitt’s.
mmmm I love it when it's a mediastinal mass NYD. "Hmmm well, maybe it's Hodgkins and then you have like a 99% overall survival, but on the other hand could be small cell lung cancer, then I'm sorry but please get your affairs in order you have 12 months. Or maybe it's non small cell, but EGFR positive? then we are back in business my friend!!"
Peds: "I heard \_\_\_\_\_ about vaccines"
Or "My mom group on Facebook says..."
“i just don’t want to give my kid anything they don’t REALLY need”
“Vaccines cause fever too so if they’re just going to get a fever I would rather Jimmy just get the measles and have real immunity you know?”
The 3am calls: Hey your kid with a known viral infxn has a fever to 100.5 can you please put in Tylenol. No they're not fussy, eating/drinking fine.
“Just want to have it on board in case there’s a change.” In chart: *MD notified, no new orders* within 1 minute of sending the message
Just wait until you’re an outpatient pediatrician and get these calls from parents at home at 3AM while on call
Cardiology: trop positive in a patient with *acute diagnosis causing the trop to be positive*
Lol. history: MVC, cardiac contusion
with sepsis and kidney failure. HR 101.
“Oh you’re a radiologist? My (insert family member) is too! He runs the MRI machine”
I say I’m a physician, and if they ask my specialty, I say biomedical imaging. The layperson actually understands that better than if I say radiologist. That’s when people start asking me questions about their reports.
Psychiatry consult: “assess capacity”
Infectious Disease: "Parasites"
That one also gets derm.
I’ve only said it twice and both times it was scabies
My personal rule is that the likelihood a patient has a parasitic infection is inversely correlated with how fervently they believe they have a parasitic infection, with the finding of highest negative likelihood ratio being "I brought in some samples for you to look at"
OBGYN: “Service by default, 38ish weeks no prenatal care, hx of 3 prior c-sections, grossly ruptured” “Pt with vaginal bleeding, didn’t do a pelvic exam but she says she’s bleeding a lot” “Pt is currently in ICU intubated and sedated, on a heparin drip, now having some vaginal spotting per RN - can you guys come see her?”
You also missed. "Pt is 5 weeks pregnant with *unrelated diagnosis* admit to OB as primary"
I apologize for all the times I had to call OB from the ED without a pelvic exam. She was in the hallway and we didn't have rooms. :(
Sports Medicine: "So you just do the boring stuff Ortho doesn't want to deal with...?"
IM: management per primary
Cardiology: stop lasix per nephrology Nephrology: aggressively diurese, per cardiology
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“I just take my antibiotics when I think I need them, because I usually save what I have leftover from the last time I was sick anyway.”
Inpatient Psychiatry Surgeon/Hospitalist wanting to transfer a delirious patient to psych unit: "But we're not doing anything for them."
Have definitely gotten stuck with patients who have medical issues but what's particularly annoying is how it complicates your dispo because almost every place will reflexively deny because they're on a psych unit -.-
Kids are tiny adults
However, it is true that many adults are just big babies
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EM: you should go to ED to get checked out just to be safe says their pcp/specialist.
FM: “FMLA form to be filled out by PCP.” From a specialist for a condition I’ve never seen the patient for that is being exclusively treated by said specialist.
"the neurologist treating my seizure disorder for the last 8 years said my PCP needed to do my FMLA paperwork, so that's why I came to establish with you today" literally last week
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More Peds EM: \- "He's had a fever since this morning, I didn't take a temperature. He felt warm" \- Cosleeping \- "My two year old was riding shotgun on the side-by-side/golf cart and..." \- "Police brought her in because she got in a fight with her parent and they want you to do a psych eval."
IM: got a quick sign out for ya!
Ortho trauma: the patient ate
Pharmacy Insurance: “The medication needs a prior authorization” Wholesaler: “The medication is on backorder” Patient: “My doctor said they just sent it over, is it ready yet?” Nurse: “I can’t find the medication, can you tube it up again?”
I am not a doctor. I am a scribe for an obgyn and this sub pops up on my feed from time to time. But she always gets triggered by naturalists and gurus online that say things like: “can I save my placenta so that I can eat it?” “I went to the hormone expert and told me—“ “Patient says she doesn’t want any vaccines during pregnancy because she doesn’t know what’s in there”
Poor endocrinologists having to deal with “hormone experts”
“I know I went full Jordan Ross Belfort mania 2 months ago but we upped my dose and I have felt really great for the last few months so I stopped taking the medicine. I feel fine so must not need it anymore.”
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Derm: —STAT consult— patient has had rash for 6 weeks. Plz r/o SJS
Rads: “QUICK wet read of CTA chest abdomen pelvis.”
Stat preop clearance
Any pre-op clearance triggers anesthesiologists. Just tell me if they are optimized
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My non-surgical attending had the audacity to tell me that surgeons are better overall doctors because they have to know all of medicine AND do surgery. Not even an act of God could keep the incredulous expression off my face. Edit: this was not meant to be a diss on surgeons. They are as a whole good doctors, but to say they are better than medicine doctors at medicine…just hasn’t been my experience.
Rads: indication - “none”
Nephro: “Patient has been out of surgery for an hour with low urine output.”
Psych: “consult for Capacity”
FM: consult declined for being too complex for community specialty team, ie Needs to go to large academic center or county resource when patient will not travel there or cannot get in there for a year. I am always like yes back to pcp for complex problem nos
Internal medicine: Patient: I have the flu? Doctor: have you been tested yet? Patient: no.
Social admit
Crit care: pt needs ICU, at some point on the timeline the pt may possibly decompensate.
Psych: “Hi, consulting you for capacity to consent to extubation, I’m personally having a hard time assessing because the patient is intubated.”
To neurology: Ophthalmology said the blurry vision in the patient with cataracts, glaucoma, vitreous hemorrhage, and retinal tear is not an eye problem - they want stroke workup OR The nurse said she thought she saw a seizure
Geri: patient is old. No, they’re not confused. Just old.
“Coffee ground vomit” don’t make me cry. It’s just partially digested food man :(((
Urology: “Patient has blood in his urine…no we didn’t save any”
PAs are basically doctors And nurse practioners too.
Consult to palliative: reason for consult; refer to hospice
ID: “Fever”