today's hospitalist

On trying to keep your shit together and succeeding

Today was a record bad day in my hospitalist career. I believe it is only one-upped in my entire healthcare career by that one time on surgery rotation. Or possibly that one time with a physician I can only refer to as the Bacon Hater. That’s a story I’ve been saving up for another time. 

Anyways, about today. Basically as a hospitalist I am the primary provider for most of my patients. Almost all of the time the specialists are always consulting providers, but of course if a specialist tells you their advice you generally follow it. A neurologist told me to either discharge a patient or, as the family was demanding, transfer her to an academic center for a second opinion because they had nothing further to offer and the patient was medically stable. And I spent 2 hours trying to transfer her to the academic center (they refused), talking to social work, arranging free medications (she had no insurance), and writing the discharge summary. I went to try and make peace with the family, got cussed out, and they were screaming that the neurologist didn’t want the patient to leave and how could I be going against his wishes?

The sad part was, the neurologist got cussed out earlier, too, changed his mind, and told the patient she could stay BUT NEVER TOLD ME.

I exited the patient’s room to find him speaking to the patient’s family member, apologizing that the hospitalist team “had miscommunicated, well they’re always changing shifts and it’s never the same provider, you know…”

And I had to stand there and listen while he threw my team, the nursing staff (and the patient’s nurse was standing there too!), and his very own nurse practitioner that had been following the patient under the bus in order to save face for himself. He want on to say “and you know NPs and PAs generally I don’t work with them very often… it gets hard with the miscommunication…” And I stood there shooting him daggers the whole time but BY GOD I HAD TO BE THE BIGGER PERSON AND BE PROFESSIONAL IN FRONT OF THIS LADY FFFFFF!!!

The conversation ended, and I ran after the neurologist and caught him trying to escape at the elevators. I could hardly keep my shit together and quite frankly was on the verge of tears I was so upset.

“Excuse me, Dr. Neurologist!” I said loudly and he whirled around. “Did we not have a conversation about this patient’s discharge this morning?”

He went on some circular vague answer, never answering my question.

“Well if you changed your mind, you needed to be crystal clear about that with the discharging service. And furthermore,” I said with my eyes beading into his, “What was that in front of the patient’s family member that you said about working with NPs and PAs? Excuse me-” as I jabbed a finger at my white coat label “-I am a PA, and I found that incredibly offensive! And calling out the nursing staff like that!”

His eyes grew a bit wide. He backpedaled “Well, you know, I didn’t mean it like that-” More vague excuses entailed. I let him drone on for a bit, then informed him that clearly there was too much “miscommunication” and that the hospitalist team would be excusing this patient from their services, thusly coordination of the patient’s workup, discharge, insurance problems, and social issues was now entirely his responsibility so that we would not trouble him further with our errors.

I bid him a very professional good day, turned heel, and went straight to my attending who supported me fully and stamped the sign off with her seal of approval.

And damn, it was worth it to keep my shit together and stand up for NPs, PAs, and nurses!

And for the record, thanks to that fiasco I was frazzled beyond belief and running extremely behind and had a million patients left to see. I dialed up my phone a friend fellow hospitalist NP and PAs and they answered me stat to help me take care of my list. Umm yeah when you have each other’s back and actually communicate and work as a TEAM shit gets done right.