Clinical Emergency?

I am doing ward cover at the moment. It is busy busy. The worse part of the job is not the amount of tasks I need to carry out, but is the fact that I need to fill in so many requests forms for imaging.

On Monday morning itself, I filled in about 10 forms for CT and ultrasound scans. It is quite time consuming, considering the fact that you need to summarise the patient's clinical history in a few sentences, and you need to propose a clinical question too. As the days went by, I became more and more efficient in filling the forms up. hehe. Guess I got better at crapping!

Having completed those forms, I needed to bring them to the radiology dept to get the scans appointed. Since I am in the acute receiving ward, these scans should be done as soon as possible, so that we can investigate the cause of the patients' problems. Organising ultrasound scans are not as bad as organising a CT scan. The reason being, there are not many CT scanners available, and the fact that, the queue is just simply long!

So every morning when I arrive at the CT scan reception, I will be bombarded by the same question, "Is this a clinical emergency?"

This is a tough question. Clinical emergency....hmm...this is a very vague question. What do they mean by clinical emergency? Apparently, it means that the scan must be done in 24 hours. From my point of view, it means that if this scan is not done asap, the patient's life is at stake. Obviously, if the patient is clinically unstable, then, surely the CT scan needs to be done urgently. However, there are times when the patient is stable, but the consultant just wants the scan to be done immediatley. I am in a dilemma.

If I do not get the scans done, the consultant will not be impressed. If I want it to be done on the same day, I have to speak to the radiologists about it. And that my friend, is the scariest part. I really do not know how to convince them that the scans need to be done today, especially when the patient's condition is stable.

There was once when I wanted a patient to have a CT scan done on the same day of his admission. And the radiologist was not happy to do it on the same day. The patient had right iliac fossa peritonism. He wanted to speak to me about it. So I went down to the dept feeling rather worried about what I should say to defend myself.

Consultant radiologist: Tell me why do you want this scan done today.

me: Well, the reason is because we are not sure why the patient is having the pain. Maybe it is appendicitis, or localised perforation or even a caecal tumour?

Consultant radiologist: Ok, let me say this again. What I want to know is, is the patient going for a surgery today?

me: It really depends on the result of the scan, that's why we would like it to be done asap.

Consultant radiologist: Doing a scan today, the patient will not be properlly prep for it. So you will get a suboptimal scan.

me: The patient has taken the gastrograffin and she has been fasting since midnight.

Consultant radiologist: No, no, that is not the point. The scan will not be optimal to be done today. What is the plan for this lady?

me: *speechless for awhile. Well, the surgeon has not decided on a plan yet....all plans really depend on the scan results.

Consultant radiologist: Look, I am not going to do the scan until you can tell me what the plan is. Performing the scan in the next morning is the best.

me: Right ok. I'll find out what the plan is. (at the same time, thinking, just do the fucking scan! That was a totally pointless discussion)

Ok...so I went back to the ward and managed to inform my SHO about it. And he gave me a look that mean what a stupid question the radiologist directed to me. The SHO just told me to go back to me and get the scan done.

Sigh. Right. Right. So I went back to the radiology dept and tried my luck again.

me: Sorry doctor, I've just spoken to the SHO and he said the plan really lies on the result of the scan.

Consultant radiologist: No no. Go speak to your consultant, not your SHO.

me: But it was the consultant who wanted the scan to be done.

Consultant radiologist: Fine.

me: Thank you doctor.

Shheessh! That was a pointless arguement, don't you think? This is an obvious clinical emergency...because the patient is experiencing peritonism and the sooner the scan is done, the faster the appropriate treatment can be carried out.

I spent about 30minutes just trying to arrange the scan for the lady. The time taken to argue could have been used to do a CT scan, which will only take 20minutes.