On the way in and out we checkout our patients to the covering physician. Just a basic rundown on why they are in the hospital, whether there are any tests that need followed up on, or situations that need to be monitored.
This was my AM checkout from the hospitalist:
Dr. No: "Yesterday afternoon Ms. Loon was told a stool sample was needed. After a while she got tired of waiting for one to appear so she dug out a sample. Doing so made her hemorrhoids bleed and and she convinced herself she was dying from a GI bleed and insisted she needed an emergent colonoscopy and EGD. I told her no. Once the bleeding stopped she eloped from the floor to the visitor lounge off the lobby to use one of the computers to work on her novel. While she was down there she felt the urge to evacuate naturally, but she was too involved in her novel to come back up to her room so she ran across the lobby to the cafe and grabbed a plastic sack to poop in. I passed her in the hallway later and she tried to give it to me. I told her no thanks."
"Then, an hour after they left, Mr. Nutso's family called and wanted to bring him back. I said no. An hour after that they dropped him off at the ED and the ED MD wanted to re-admit him to us. I explained that our part in his care was complete and told him no. They discharged him from the ED since he didn't have any medical problems. An hour later he was brought back by ambulance because he was acting a fool, rolling in the grass at his wife's workplace. The ED called again and I told them no. An hour after that he was brought back to the ED by the police and I told them no again. The police didn't want to take no, so I told them to call Psych. They were the ones who said he had capacity so we could discharge him. A few minutes later the psych on call tried to tell me to re-admit him. I told him no. Mr. Nutso is in the ED acting psychotic, not cancerous, so you take him if you think he needs admitted. He tried to tell me to admit to our service and they'd consult. I told him no. He said the guy wasn't safe, I told him that according to their note from 7 hours ago he has capacity. He said, "Well, I didn't think you were going to discharge him!" I still told him no and then called his attending, and after I told him no several times he finally agreed that a psych admit was more appropriate."
"Then Mr. Drugs nurse called and said he was insisting on keeping his home meds in his room and wanted orders saying I thought that was ok. I told her no, he has oxycontin and oxycodone, send them to the pharmacy. I think they're still in his room, but I'm not gonna say that's ok."
Then Ms. Swallowless's ex-husband caught me and was just determined that we feed her. I told him no. A while later the nurses caught him trying to feed her, we explained again, I told him no again. Later he tried once more and security was called. They told him no as they kicked him out. Chest Xray is pending since she probably aspirated again."
"Next Mr. 21 wanted to go outside and party with his friends with his chemo hooked up. I told him no. He tried to sneak down the elevators, but so far the the nurse has caught him."
"She didn't catch Mr. Confused and he eloped in a hospital gown, barefooted, with an IV pole, and caught a crosstown bus. The police brought him back after they found him sitting on a bus bench trying to remember where he lives."
Other than the regular stuff like pain and sleep meds that's all that happened. Have a great day."
And people wonder that I don't hop out of bed every morning eager to go save lives!