Today I was asked how I do my job and put up with all the BS.  “Laugh often,” was all I could think of.
A selection of some of the odd things I’ve come across in the last 6 months back in the hospital system.

1: First day

After reviewing an agitated patient, I suggested that the treating team prescribed olanzapine oral or intramuscularly PRN.  The medical reg asked about olanzapine intravenously (IV).  I advised against this, given the propensity to cause cardiac arrest and also for the fact that it’s never actually done anywhere.  When I reviewed the patient again the next day, he had been charted for Olanzapine… IV.

Fortunately, not given.

It was going to be a long 6 months.

2: Worst referral ever

An Obstetrics registrar called me up and said: “patient patient suicide suicide.”

Then he hung up.

I was reminded me of a med reg I worked with some time ago who once called the family of a patient and shouted “code blue code blue” at them.  Also inappropriate, also utilising a 4 word phrase of only 2 words – and also a former O&G registrar – the similarities are… disturbing.

Apparently first registrar had previously made single word phone referrals (“bone”) to orthopaedics – which was apparently acceptable.

 

3: Already on one!

A surgical patient who had been in hospital for a month was referred “a patient who looks depressed, ?need to start antidepressant”
The patient was already written up for one, but had been only given once during his entire admission.  He said, ‘the treating team stopped giving it to me, I don’t know why.’
The treating team didn’t know either!
They were also unaware drug in question was an antidepressant…

 

4: Anorexia Nervosa 1

A girl with anorexia nervosa weighing 35kg, hypotensive, with severe bradycardia and a Body Mass Index of 12 was sent home by the Emergency Department.  Apparently they thought she was ok to go home.  Whoops.

 

5: Check the damn ECG

Referral: 80 y.o woman with query psychosis.  No psychiatric history, delirium excluded as all medical causes excluded.

On review, psychiatrist finds NSTEMI and trigeminy on admission ECG.

Expression on medical team’s face… priceless.

 

6: Bad drug chart 1

A patient was admitted following alcohol withdrawal.  He was prescribed diazepam 20mg 4 hourly for a week (120mg/day), this was reduced to 20mg daily for 3 days, then it was all ceased.  Unfortunately this patient went from a an alcohol delirium to a benzo withdrawal delirium.

A week later I was asked by a med reg to wean a patient off benzodiazepenes, because they didn’t know how to do it.  I believed them.

 

7: Bad drug chart 2

In a 4 hour period, a 95 year old demented woman was given a total of 15mg Midazolam IM, 15mg Olanzapine IM 4mg Haloperidol IM… and a 10mg Temazepam to help her “sleep”.

Not a combination I would give to a healthy 20 year old, let alone some in her mid 90s.

 

8: Accidental pneumonia

A bed bound patient from a nursing home was admitted with a delirium.  On review, I recommended that both regular and PRN diazepam be ceased.  This didn’t happen, the medication continued to be given in large quantities and a few days later, the patient had developed aspiration pneumonia.  Winner.

 

9: Another inappropriate referrals

Received a faxed referral: “Pt Admitted for sudden onset headache, nausea, vomiting, fever, photophobia.  Is now agitated and confused.  Was well this morning according to family.  Requesting psychiatric input for diagnostic clarification.”

Referrer: “We think this patient needs a psychiatric admission…”

Me (incredulous): “You are kidding.  Have you got done a Lumbar Puncture?”

Referrer: “Umm… no.  We’ll get back to you.”

She had viral encephalitis.  They never got back to me.

 

10: LOL referral

Faxed referral: “Plz treat pt to so he doesn’t keep bouncing back with panic attacks”

Note from the file:  “Patient has a history of COPD, cancer with lung mets.  Oxygen sats dropped to 70% at home, patient was cyanotic when ambulance arrived.”

Panic attacks don’t drop your sats to 70.

 

11: “Patient not eating ?depressed”

When I saw this patient, he was was physically unable to reach his food tray.  Or his call buzzer – strategically placed, I imagine.  No surprises he wasn’t eating.  Then I was asked why a food chart was necessary “because he wasn’t eating.”

 

12: Bad Dreams

Referral note: “Patient anxious, having vivid dreams, nightmares”

The patient actually described a delirium, brought on by alprazolam prescribed by the treating team.

 

13: “The Surgery Went Fine”

“Please review Mrs X 90 years old, because she is lacking motivation post op and ?depressed.  The surgery went fine.”

She had undergone major abdominal surgery: splenectomy, pancreatactomy, and partial bowel resection.  Patient had died the day before the referral was made… WTF.

 

14: Anorexia Nervosa 2

Case note entry querying a change in diagnosis from “anorexia nervosa” to “anorexia” because the patient is no longer anxious.  (What the hell??)

 

15: Bizarre

Referral: “Patient has become angry, think she needs a psych review”

Patient had surgery cancelled 2 weeks ago, and would like an explanation why.  Doesn’t know what’s going on or what’s going to happen bext.  No entries in file from surgical team in during this period – I was reminded of a surgical fellow who used to tell students that you should never write in the notes so no one can sue you.  He also used “impotent” and “incompetent” interchangeably.