This is Day 9 of my 12 day working week. As the week progresses, things seem to be getting more out of control, crazy and frustrating.
On Sunday, I spent at least 6 hours in one of the wards sorting out a very ill patient. The thing that frustrated me the most was the fact that there was no proper plans created for the patient. The diagnosis made by the patient's usual team was of X, however, when the patient was seen by another team, the diagnosis was Y. The interesting about this was the team that diagnosed the illness X, is a specialist in the illness Y. So the diagnoses were sort of going against each other.
I was stuck in the middle, and I was asked by one of the teams to get ITU to review the patient....Unfortunately, they gave me a big mouthful because the diagnosis was unclear. So I resorted to telling them what I personally think it was. I am sure many junior doctors out there have been in the same position as me. It is just so difficult and uncomfortable being in the middle of an argument between 2 teams.
To add to the misery,
I really wanted to "aou huit" today.... that is a chinese phrase, which literally means "vomit blood." A patient was extremely agitated in the ward because of a severe infection. The patient has no capacity whatsoever to make decisions. A few doses of sedation was given earlier, but they had no effect on the patient at all. The interesting thing was again, there was no clear plan from the ward round about addressing the agitation.
So there I was, holding a syringe filled with diazepam, gently sedating the patient intravenously to allow us to provide treatment. I dislike doing that....but had no choice because I was doing it in his best interest.
The joys of being a doctor.....NOT!
4 comments:
Not very fun is it! Unfortunately, that's how it is most of the time... I'm glad I'm no longer doing med :P.
Hopefully I won't have to do it anymore! *crosses fingers*
Where were your seniors? You didn't mention seeking senior advice on either case.
Diazepam is not the choice of sedation in the management of delirium and actely agitated patients. You should familiarize yourself with the NICE and RCP guidelines.
yeah, i did seek help from seniors. but unfortunately, they werent too helpful.
first case:
consultant was there with me. consultant insisted that diagnosis is X, and not Y. ITU felt that was ridiculous. i told cons about that, cons not happy, and asked me to call itu again. consultant said patient shouldnt be treated for illness Y. and guess wat? patient responded to treatment for Y.
second case:
doses of haloperidol didnt touch him. no lorazepam injections in the hospital, except oral version. pt refusing to take any oral tablets, so that is out of the question.
senior, ie, consultant was there. but didnt know what to do (and i am not joking). then advised me to contact clinical governance person to give us advice on dealing with patients in this circumstance.
so these were tricky cases.
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