Dr. Andy

Reflections on medicine and biology among other things

Friday, March 04, 2005

The Block

The Cheerful Oncologist's post about the last call had me reminiscing all week about residency.

I think one of the most important skills to develop as a young doctor is advocating for patients, even against your superiors.

One night as a second year pediatrics resident, I was on call at a community hospital west of Boston. I got a call from an attending, a pediatrician in practice

Att (heavily accented English, cliched but true): I have a patient I want to admit to the floor.
Me: Okay, what's up
A: It is a 4 year old girl. She fell riding her bike and was unconcious. She is at Hospital Y ED(Note: really small hospital, with no pediatrics).
M: Did she get a head CT?
A: Well they tried, but she woke up too much so they couldn't
M: How is she now?
A: She is mostly asleep but she's moving around a lot.
M: Neuro exam?
A: I'm not sure
M: Can they wake her up?
A: Just a little bit, but she still isn't walking or talking. I haven't seen her, the ED doctor from Hospital Y called me. I figured we could just admit her to you overnight and she how she is in the morning.
M: That sounds like a bad idea. Shouldn't she go into Boston to get a head CT?
A: I just think that would be a hassle for the parents, to go all the way into Boston.
M: I drove out in 20 minutes this morning. There is no traffic at 10PM on Sunday. Tell the ambulance to drive right past here and take her to Boston
A: Do you really think so? Couldn't you just watch her, then send her to Boston if things change?
M: No. This is a girl with known head trauma and mental status changes. She needs a head CT tonight. If I watch her and she deteriorates, I have limited ability to get a head CT here (CT and adult techs available but no radiologists to read, although I should be able to pick up a bleed) and, more importantly no neurosurgeons (let alone pediatric neurosurgeons) to do anything about it. She needs to get the CT tonight and have neurosurg avaiable.
A: Okay, but it seems like a big hassle.

She went to Boston, her CT was fine, she was observed overnight, looked great the next morning and went home.


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