As a new intern, when they start to ask why tf I would consult them for something so stupid I just respond with "my attending wanted it". Usually, the fellow/resident on the other side totally understands and drops a three sentence note essentially saying everything is fine this was dumb.
Yup when I was rotating through Endocrinology and rounding on a patient being co-managed with Nephrology. We found out that their consultant changed our prescribed oral hypoglycemic drugs without informing us.
No worries, your infectious disease fellow will sigh, then spend an hour digging through the patient's chart, write a short novella as a note including a multiple paragraph assessment explaining how the patient doesn't have an infection and end with a single line plan: Discontinue antibiotics. ID will sign off. Thank you for this consult.
As a nurse, when nonsense verbal orders given I find they reconsider when I hand them the chart and ask them to write it... was most effective when indeed was on paper but... amazing how many times they didn't have time to do it on the computer. Love that in nursing verbals are supposed to be limited, maybe attendings need same.
Since many viewers of this channel are NOT in the medical field can someone please elaborate on what this means and how it relates to the video topic??? Quote: "...in nursing verbals are supposed to be limited, maybe attendings need same."??? Thanks in advance! 🙂
"Better do what the boss says" is so relatable 😭 Consultant says "let's do this scan/consult" = "YOU do this while I go to my office and drink coffee" 😂 LESSON: ALWAYS ASK WHY! As long as it's with the aim of helping the patient, I'll do whatever
Yup...I always ask what the clinical question is when the attending demands a consult I dont agree with... Gets worse when they answer with "well, he had polypectomy 15 years ago that proved to be cancerous...dont we need Oncology?" Me screaming on the inside "to tell us WHAT???"
Hahaha this is spot on! So true! Eventually I would say, "this is what my attending wanted. If you have a question then you can ask him to explain because I wasn't given an explanation either." Nine times out of ten once questioned by another attending they would change their mind.
Brilliant! Had a pateint with recurrent fevers and after multiple blood cultures came sterile, my senior made me consult ophthalmology for endophthalmitis, with zero eye symptoms, when I asked him why he said just to rule out. Ophthalmologist chewed me out afterwards... On the bright side 2 days later a different consultant joined the unit and started an antifungal which made the patients fevers disappear completely
When you reach that point at the end of your training....😂 ....And then you become the junior consultant and you behave even more defensively than your former boss!!!
This is seriously my life every single day as an inpatient coder. Discharge summary: Patient had sepsis, no infection identified, did not meet SIRS criteria. I cry into my coffee.....
Lol, I work in the UK so there is no coding, but every shift I get a handover for patients who are 'generally unwell', which I imagine must be pretty hard to code for. Obv we then look for reasons for that, but with older patients, it's not unheard of to be admitted as generally unwell, query infection, no source found, bloods unremarkable, spend a few days in with physio and observation and then go home. Like, if you had to explain to an insurance company why they came into hospital, or what treatment we gave them, it would be pretty difficult! But they did need to be in hospital I promise!
I mean... Once we've gotten enough incessant coding queries about sepsis or severe protein calorie malnutrition, we start just putting it everywhere so you stop bothering us
Then you have to deal with the nurse. My strategy is usually not to fight the orders, but to let the patient know that they have full autonomy to decline anything they don't agree with (when they legally can consent) and update them on the plan. Then you can just tell boss that they refused all the stupid orders & actually have to go talk to the patient
And now their insurance won’t pay for anything due to their noncompliance. So the patient is bankrupt and the hospital doesn’t get paid. Excellent plan. 🙄
SO TRUE - in EMS as well, having to call medical control to clear an RMA for someone having a panic attack because technically their respiratory rate is too high and then medical control insists on sending a paramedic unit to come assess her and now you're getting funny looks by the medics for getting them requested for a panic attack.
I'm not even in the medical field, but I've spent SO much time in hospitals over the last 20 years due to my husband's chronic health issues, & now, my own, that I really can feel for the characters in these skits. It's a wonder to me that I've never seen a young doctor just hurl themselves right out a hospital window to end the madness!!
Lol, that's why the windows in my hospital don't open at all. It's not for patient safety like they say, it's to stop the staff hurling themselves out to get some relief.
The tragedy is the range of emotions from the gut feeling of "Something's not right but idk what..." to "Hey, huh? This doesn't make sense because of (evidence)." And then immediately doubting your concerns because they go "No, no, I know this. I'm the one with more experience." Sighhhhhhhh
So entertaining. Got to do what the boss ordered unfortunately. Despite having clear doubts. Just do what big boss doctor ordered and have a peaceful outcome. It must be so pressurising to have to put up with. Great content as usual Dr. Schmit. Thank you so very much. Kindest regards from England.
I sometimes come up with creative ways to get around certain things I don't agree with. But for things like this it's hard. I prefaced a similar consult to ID with something along the lines of "Hey I'm sorry in advance for this consult but my attending wanted it..."
Now you can ask what lucky med student wants some extra experience** calling in a consult? (**experience getting yelled at by a sleep deprived sub-specialist)
As an RN this had me laughing hysterically. We have to follow the orders given by a dr but often times we know they don’t make any sense whatsoever. Especially after a few years of experience.😂
And unfortunately that's how it is sometimes. I tried to discuss this matter with an attending that was notorious for nonsense workup. He said I know that the patient does not require this or this but we do this to protect our assess. In a resource rich country like the US where medicolegal cases are a big deal, yeah you are going to order that unneeded brain MRI or throw an EEG, or just start super expensive empiric antibiotics just to not miss anything. That is typically not the case anywhere else except for the US. Unfortunately the families and lawyers are just waiting for any mistake to sue to make a bank off the hospital. Attendings always think medicolegal here no matter what is the cost while residents who are protected typically think more in a scientific and cost effective way.
I got lucky during my residency training. Whenever the doc ordered something that seemed nonsense to me I just asked "what should I say as justification?" and usually after the 3rd/4th time they'd reply.
‘Hi this is SuperLady with the ICU, I’ve been instructed to consult with cardiology about Mr. Jones. Why wasn’t exactly explained but here’s his info, thanks for the help!!!’
as im in the hospital with sepsis right now and here I thought my 104 fever, 50 breaths a minute, and 180 heart rate wasn’t that serious this absolutely made my night
Imagine, you are the patient and you know you are the hot potato....🥴🏥🛏🔥🥔🤷🏼♀️...🤷♂️...🤷... 🥴😤💰🏥💰🤷🏼♀️ And that is actually how it felt to be in that situation.
Make sure you know if your patient doesn't have a gall bladder..OR liver is a bit inflamed..some vitamin and minerals do not get absorbed well if no gall bladder or liver is congested...REMEMBER..those with low thyroid do not register a normal temperature..OR fever...so check history of thyroid problems..most with hypothyroidism have a temperature 1-2 degrees lower naturally...so anything over 99° might actually signal an infection..if they had a regular body temperature!
Oh my god, this couldn't be more accurate. Haha, order an MRI and LP for pt 92 y female who has sepsis after symptomatic improvement with IV ABS on background refractory almost palliative melanoma.😂
OK for you med students out there...Do very much so say "Why cause the ICD 10 codes are going to be needed in order for insurance to pay". And, once that gets brought up, docs back down right quick and they begin thinking more clearly!
And then ID team will reject the referral and then the boss will scold you for not referring to them correctly. He then goes on to refer the case himself and the referral was accepted. Then he’ll say “you say how easy that was?! You young doctors nowadays need to learn how to present cases properly!” Just another day as a houseman.
"Older than... me?" had me loling. Also, if I had a dollar for every time a patient family member swore that the temperature of 98.9 was a fever because "mom always runs 97.5 so a temp of 98.9 for her is like a normal person having a temp of 100.1!" Like, sir, even if that was true, 100.1 is barely a low grade temp. That alone is not worth a call to the MD unless they have other indicators of potential sepsis. And I am absolutely not paging a physician to let them know that my patient has normal temp. #SorryNotSorry
Absolutely the life of a senior resident trying to justify consults you don't agree with.
As a new intern, when they start to ask why tf I would consult them for something so stupid I just respond with "my attending wanted it". Usually, the fellow/resident on the other side totally understands and drops a three sentence note essentially saying everything is fine this was dumb.
@@taurosground Thank you for this interesting consult.
Tbh he did well ❤😂
“Kinda has sepsis…kinda??” 😂😂 the skits keep getting better lol
So relatable! How about the opposite problem: when the attending refuses to let you consult other specialists because “WE can manage that.”
Yup when I was rotating through Endocrinology and rounding on a patient being co-managed with Nephrology. We found out that their consultant changed our prescribed oral hypoglycemic drugs without informing us.
No worries, your infectious disease fellow will sigh, then spend an hour digging through the patient's chart, write a short novella as a note including a multiple paragraph assessment explaining how the patient doesn't have an infection and end with a single line plan:
Discontinue antibiotics. ID will sign off. Thank you for this consult.
*interesting consult.
Otherwise spot on.
There should be emojis in Epic
"We're just being cautious... 'cause he's... older." "He's 56." I am DEAD 🤣
Watching with my 57 year old eyes 😢
As a nurse, when nonsense verbal orders given I find they reconsider when I hand them the chart and ask them to write it... was most effective when indeed was on paper but... amazing how many times they didn't have time to do it on the computer. Love that in nursing verbals are supposed to be limited, maybe attendings need same.
I am guessing that it makes sense till they read it and see it all in one package. Some brains are so weird that way. Processing error...
"Can I get that in writing?"
Kryptonite against bad bosses...
Since many viewers of this channel are NOT in the medical field can someone please elaborate on what this means and how it relates to the video topic??? Quote: "...in nursing verbals are supposed to be limited, maybe attendings need same."??? Thanks in advance! 🙂
"Better do what the boss says" is so relatable 😭 Consultant says "let's do this scan/consult" = "YOU do this while I go to my office and drink coffee" 😂 LESSON: ALWAYS ASK WHY! As long as it's with the aim of helping the patient, I'll do whatever
Well said!
@@Doc_Schmidt this is one of the most relatable skits you've ever made 😂 My "clinical acumen" is crying on the inside 😭
Yup...I always ask what the clinical question is when the attending demands a consult I dont agree with... Gets worse when they answer with "well, he had polypectomy 15 years ago that proved to be cancerous...dont we need Oncology?" Me screaming on the inside "to tell us WHAT???"
Unless of course the answer you always get is: "Because I said so and I will not bicker around with you about my orders!"
Hahaha this is spot on! So true! Eventually I would say, "this is what my attending wanted. If you have a question then you can ask him to explain because I wasn't given an explanation either." Nine times out of ten once questioned by another attending they would change their mind.
Brilliant! Had a pateint with recurrent fevers and after multiple blood cultures came sterile, my senior made me consult ophthalmology for endophthalmitis, with zero eye symptoms, when I asked him why he said just to rule out. Ophthalmologist chewed me out afterwards...
On the bright side 2 days later a different consultant joined the unit and started an antifungal which made the patients fevers disappear completely
Lol, I’m Tori from pharmacy and I would DEFINITELY call to find out why you’re ordering a Vanc on 18
When your attending thinks he's Dr. House
"Pharmacy made them do it " I laughed so hard 🤣🤣
Wow it's amazing how little medicine changes in different parts of the world 😂
Similar vibes to me, a nurse, giving an update to the patient’s family member when the plan of care doesn’t make sense 😂
When you reach that point at the end of your training....😂
....And then you become the junior consultant and you behave even more defensively than your former boss!!!
"I'm just following orders here" would have been a great line in this scenario🤣
They are residents. Which means they have medical licenses, so that response won’t fly.
@@Judo593 so a resident can refuse to so something their attending told them to do? How would that work out?
This is seriously my life every single day as an inpatient coder. Discharge summary: Patient had sepsis, no infection identified, did not meet SIRS criteria.
I cry into my coffee.....
As a Sepsis core measure data abstractor I agree 💯😁
So no CDI spec to query :(
Lol, I work in the UK so there is no coding, but every shift I get a handover for patients who are 'generally unwell', which I imagine must be pretty hard to code for. Obv we then look for reasons for that, but with older patients, it's not unheard of to be admitted as generally unwell, query infection, no source found, bloods unremarkable, spend a few days in with physio and observation and then go home. Like, if you had to explain to an insurance company why they came into hospital, or what treatment we gave them, it would be pretty difficult! But they did need to be in hospital I promise!
R53 - malaise and fatigue.
I mean... Once we've gotten enough incessant coding queries about sepsis or severe protein calorie malnutrition, we start just putting it everywhere so you stop bothering us
Then you have to deal with the nurse. My strategy is usually not to fight the orders, but to let the patient know that they have full autonomy to decline anything they don't agree with (when they legally can consent) and update them on the plan. Then you can just tell boss that they refused all the stupid orders & actually have to go talk to the patient
Except then the care team stigmatize the pt in his chart by recording the he “refused” the ordered plan of care...
And now their insurance won’t pay for anything due to their noncompliance. So the patient is bankrupt and the hospital doesn’t get paid.
Excellent plan. 🙄
SO TRUE - in EMS as well, having to call medical control to clear an RMA for someone having a panic attack because technically their respiratory rate is too high and then medical control insists on sending a paramedic unit to come assess her and now you're getting funny looks by the medics for getting them requested for a panic attack.
I'm not even in the medical field, but I've spent SO much time in hospitals over the last 20 years due to my husband's chronic health issues, & now, my own, that I really can feel for the characters in these skits. It's a wonder to me that I've never seen a young doctor just hurl themselves right out a hospital window to end the madness!!
Lol, that's why the windows in my hospital don't open at all. It's not for patient safety like they say, it's to stop the staff hurling themselves out to get some relief.
Same with my hospital they had a resident jump out of one a few years back and now noone can open any windows
a lot of us would definitely love to hurl ourselves out the windows... wish i was joking
The tragedy is the range of emotions from the gut feeling of "Something's not right but idk what..." to "Hey, huh? This doesn't make sense because of (evidence)." And then immediately doubting your concerns because they go "No, no, I know this. I'm the one with more experience."
Sighhhhhhhh
Hospital pharmacist here. You are KILLING me! 😂
This cracked me up, the frantic looks, the pseudo seriousness 😊
So entertaining. Got to do what the boss ordered unfortunately. Despite having clear doubts. Just do what big boss doctor ordered and have a peaceful outcome. It must be so pressurising to have to put up with. Great content as usual Dr. Schmit. Thank you so very much. Kindest regards from England.
I sometimes come up with creative ways to get around certain things I don't agree with. But for things like this it's hard. I prefaced a similar consult to ID with something along the lines of "Hey I'm sorry in advance for this consult but my attending wanted it..."
@@molossers6499 Hi Molossers. I think that response is excellent. Wishing you all the very best from England.Kindest regards.
This is one of those times that I'm thankful I am a nurse and I can just leave the politics to the doctors 🤣
Now you can ask what lucky med student wants some extra experience** calling in a consult?
(**experience getting yelled at by a sleep deprived sub-specialist)
"Thank you for asking me to participate in the care of this most interesting patient." Signed: Private consultant.
This reflected so much of my internship year in India I just burst out laughing and went to go show this to my radiologist dad lmao
X-ray tech here! I have this conversation several times a week 🤦🏽♀️😂😂 Great representation once again Doc
This is absolutly when I just say "yeah i don't know either, i was just told to do x, so i am"
That basically described my weekend rounds with the ICU Consultant 😂
As an RN this had me laughing hysterically. We have to follow the orders given by a dr but often times we know they don’t make any sense whatsoever. Especially after a few years of experience.😂
Been there, done that. Medical residency should pay more! LOL
So you know you have a nonsensical boss when every department calls you about his stupid treatment plan.🤣
Non medical viewers will think this is comedy. Medical viewers “ Yep. True story, happens at my hospital all the time.”
I love how all your videos are equally funny and plausible, I could relate to so many situations.
"Cause he's older, he's 56, older than me" 😂😂😂
This explains where my time goes all day….
Plot twist 2 hours later he's in full blown septic shock
Might as well order a CTPA! Gotta cover all the bases!
And unfortunately that's how it is sometimes. I tried to discuss this matter with an attending that was notorious for nonsense workup. He said I know that the patient does not require this or this but we do this to protect our assess. In a resource rich country like the US where medicolegal cases are a big deal, yeah you are going to order that unneeded brain MRI or throw an EEG, or just start super expensive empiric antibiotics just to not miss anything. That is typically not the case anywhere else except for the US. Unfortunately the families and lawyers are just waiting for any mistake to sue to make a bank off the hospital. Attendings always think medicolegal here no matter what is the cost while residents who are protected typically think more in a scientific and cost effective way.
Hahahha poor Ben being caught in the middle. I love all the wigs! Each character was played to distinctly too. Thanks for another great video!
“He runs low” 😂
Then imagine explaining this to a family member who is nurse as nurse😂😂😂
For me a temp of 99.2 may be a low grade fever as my norm is like 97.6! These skits are so funny! Bless the medical team and students!❤❤❤
I legitimately feel this in my soul.
It's how you need to word the call "My consultant has asked me to call you regarding xyz"
I got lucky during my residency training. Whenever the doc ordered something that seemed nonsense to me I just asked "what should I say as justification?" and usually after the 3rd/4th time they'd reply.
Doc Schmidt, you are amazing! This is accurate. It's nice to see same things here in India except the radiology and pharmacy part!
this is hilarious and has described the past 5 years of my life as a resident
‘Hi this is SuperLady with the ICU, I’ve been instructed to consult with cardiology about Mr. Jones. Why wasn’t exactly explained but here’s his info, thanks for the help!!!’
LOVE THIS!! I've worked with Docs like this attending. 🤣🤣🤣
Had me rolling in the aisles😂 thanks!
It’s scary how relatable this is
I love that your phone is one of the first iPhone lol! Also as a new NA fresh off orientation, I loooooove your videos
That’s why you get a $10,000 hospital bill for three hour visit.
You should’ve done a collab with doctor glaucomfleckin on this one 😂
I feel like you guys would do great together
Still laughing... OMG, this one was priceless.I feel for you all in medicine....
Seen this so many times. The worst is explaining to the patient why when you don’t agree
hey wigs are BAAACK!
Had a meeting today that sounded just like this!
as im in the hospital with sepsis right now and here I thought my 104 fever, 50 breaths a minute, and 180 heart rate wasn’t that serious this absolutely made my night
Imagine, you are the patient and you know you are the hot potato....🥴🏥🛏🔥🥔🤷🏼♀️...🤷♂️...🤷... 🥴😤💰🏥💰🤷🏼♀️
And that is actually how it felt to be in that situation.
Ugh and sick people have to wrangle with insurance to justify imaging.
OMG I’m that X-ray tech! 😂 sometimes I feel so bad asking but come on!!!!!! Really your reason is cause my senior…. I’m dying.
Even more frustrating when the patient drops their bundle 30 min later and your boss was right! How do they do that?
Relatable... So, so relatable.
“The attending said so…”
Nothing like managing Hospitalist fraud as comedy. 👌😎
Don’t worry, the nurses will protect you 😂
How I felt as a nursing student being told to give meds to a patient who didn't present need for them
But I got yelled at last week for asking for blood cultures on a patient with new onset temp of 102. Who was not on antibiotics. 🤦♀️🤦♀️
Tori is having a great hair day!
Always
🤣🤣 As a former resident I approve this message 👍
I am laughing like crazy.
_so many blessed times_
Omgosh. Been a nurse forever. So true. Chief resident or attending ordering some nonsense. So embarrassing. 🤣 kind of has sepsis. I'm dying. 🤣🤣
Hahahahah Tori from pharmacy seems a bit frustrated with these shenanigans
Sort of like all of us pharmacists🤣
Make sure you know if your patient doesn't have a gall bladder..OR liver is a bit inflamed..some vitamin and minerals do not get absorbed well if no gall bladder or liver is congested...REMEMBER..those with low thyroid do not register a normal temperature..OR fever...so check history of thyroid problems..most with hypothyroidism have a temperature 1-2 degrees lower naturally...so anything over 99° might actually signal an infection..if they had a regular body temperature!
Sorry hon, ha, ha ??!! That is why I was always a boss in my profession
Isn't this one of the ways we get accelerated antibiotic resistance? 😳😵
Oh my god, this couldn't be more accurate. Haha, order an MRI and LP for pt 92 y female who has sepsis after symptomatic improvement with IV ABS on background refractory almost palliative melanoma.😂
A full body CT! I wish that were a joke, but I’ve run across it before.. ugh.. then having to explain to a Dr…
🤣🤣🤣🤣🤣 Exactly, "my attending wanted it". Ugh
OK for you med students out there...Do very much so say "Why cause the ICD 10 codes are going to be needed in order for insurance to pay". And, once that gets brought up, docs back down right quick and they begin thinking more clearly!
Lol you aren't alone :)
Wow, I know exactly how this feels 😂
No sense??? MY BOSS WOULD BE SICK IF HE WOULD MAKE SENSE!!!
Ahh I see your boss is an ER doc
Awesome!! Loved it!
Heavy guru
‘Are you ok?’
*no im not ok* 😂
And then ID team will reject the referral and then the boss will scold you for not referring to them correctly. He then goes on to refer the case himself and the referral was accepted. Then he’ll say “you say how easy that was?! You young doctors nowadays need to learn how to present cases properly!”
Just another day as a houseman.
This is your nest sketch yet
"He runs low?"
This is how banking works too!
God love ya! Nailed it.
"Older than... me?" had me loling.
Also, if I had a dollar for every time a patient family member swore that the temperature of 98.9 was a fever because "mom always runs 97.5 so a temp of 98.9 for her is like a normal person having a temp of 100.1!"
Like, sir, even if that was true, 100.1 is barely a low grade temp. That alone is not worth a call to the MD unless they have other indicators of potential sepsis. And I am absolutely not paging a physician to let them know that my patient has normal temp. #SorryNotSorry
😂😂😂 this is gold!
I completely understand you 😆😆😆