Life is ironic. I just wrote that post about Fournier's gangrene on saturday, and I took a call this morning (monday) from the ER about another rule out Fournier's.
This particular phonecall was marred by one of the rudest encounter with an ER doc since I've been in practice. On the whole, I have a very congenial relationship with all my ER colleagues. Since I belong to a big urology group that practices at several locations, we interact with 6 different ERs in town when we are on call, and I pride myself on being nice, helpful and minimally obstructive to patient care when the ER calls me. I am quick to accept admissions with very little grumbling, and promptly see patients who need to be seen in the ER.
This particular ER physician must have been new since I've never heard of him prior to this morning. He told me about a patient who came in with groin pain x 3days and he ordered a CT scan showed an abscess in his perineum extending from under his scrotum to his rectal area. The radiologis's report had the words "Fournier's gangrene".
I inquired the ER doc about the physical exam to get more details on the patient and whether he thought a general surgery consult was warranted because of the possible extension into the peri-rectal area. After asking me whether I was a resident or an attending in a snide tone, he proceeded to tell me that it was my job to figure that out and he was just reporting what the radiologist told him. Taken aback, I paused for a few seconds because I really did not expect such a vitriolic response. I then requested that he admit the patient and he said he couldn't do it because he was too busy. Incredulously I asked him: "you can't have Admission find him a hospital bed because you are too busy?" (Usually, when a patient gets admitted through the ER, the admitting doc does not have to call Bed Control herself and arrange the admssion. The ER staff puts in the request and it is done...) The ER doc replied that he could request a bed but wouldn't write the orders for me. Exasperated I informed him that I never asked him to write orders, but could the patient get started on some IV antibiotics right away. He grudgingly agreed to get this done.
I really hate morning that start off like this. It really leaves you with a bad feeling the rest of the day. I understand that this ER doc was probably nearing the end of his busy shift and he was cranky. But I do not think the questions or requests I asked were unreasonable, nor did I start off being rude first. He may have dealt with other rude consultants throughout his shift, but it was the first time we had ever talked on the phone. Can't we all just get along?
Monday, March 12, 2007
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7 comments:
On behalf of reasonable ER docs everywhere, you have my apologies.
You should nicely discuss your recent interaction with the group chairman of the ED this miscreant works in. While we all have different styles, antagonism isn't really helpful.
Thanks for taking good care of the patient, and I'm sorry a few of my colleagues are jerks. (Someday I'll tell some stories of Urology consults, though).
GruntDoc
Well--here's what we all want to know--WAS it Fournier's???
I sure hope not, for the patient's sake and yours.
GruntDoc: no need to apologize. Most of my interactions with ER physicians have been quite personable and amicable, and I just wrote about this one because it was such an anomaly. And I'm sure you can tell us about some of the jerk consultants you've dealt with....
Terri: not Fournier's. Most physicians who have never truly seen Fournier's gangrene use this term too lightly and too often.
Someone mentioned in my previous post that if you have to ask to "rule it out", it probably isn't Fournier's...
Yes, once you've seen Fournier's you'll never miss it again. Ever. It's nasty!
As an ER doc who also does hyberbarics, I get to take care of them before and after the surgery.
One question still linger for me though, sometimes I call up the general surgeons, they tell me to call the urologists. Sometimes I call the urologists, they tell me to call the general surgeons who can handle it just as well. What are the rules?
No real set rules. Most urologists will take care of Fournier's patients if the process involves the scrotum and perineum.
However, if there is peri-rectal involvement, spread of the disease into the buttock, upper abdomen or thighs, I like to have general surgery around. In a couple of the worst cases I've seen, general surgery actually had to perform a colonic diversion.
If the infection spares the scrotum/genitalia and involves only the peri-rectal area and perineum, I think general surgery should be consulted.
I would have politely asked te ER doc, "how exactly do you spell your name?" I have to say, I haven't had this kind of experience from the ER. Are you at an academic center or somewhere where there are both attendings and residents?
Regarding the Fournier's..
If the ultrasound report, or even the ER doc, mentioned the "F" word, I just start getting out of bed to go in to check it out. I think even if I know it's likely bogus, it was mentioned or written down, so it's now part of the record. I just don't take a chance. There are SO few things in urology that really need for me to get my lazy butt out of bed. This is one of them.
The other thing I sometimes do.. selectively with certain docs.. is just come right out and say, "so john, just tell me, do you think I need to come in now?" He says yes. I say "i'm on my way, thanks." Like I said.. selective.
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