Medical Consulting

This is a light hearted post I wrote back when I was on the consult service

Dear surgery intern: “give me your tired, your sick, your poor huddled masses yearning to be free”…of your horrible care!

As an exhausted and frustrated house medical consultant for all the surgical specialties during the last three days, I’ve come to this one conclusion: Every patient in the hospital deserves to be on the internal medicine service and all the other services should be strictly consulting.

In the Mad House, medical consulting is restricted to third year medical residents. I remember how during the second year my elders would tell us of the horrors they encounter on the service as they shared with us the full list of confusing and often conflicting orders they found in the surgical charts. I never thought these to be true, probably exaggerations added for comedic value.

Oh. My. God!

For the sake of the health of future patients I offer all surgical residents, or any other specialty for that matter, these informative suggestions as general guidelines for the future care of your most favorite patient. Consider yourself forewarned lest your name be mentioned behind the closed doors of our favorite call room.

-In diabetic patients, generally, 5% Dextrose (D5) is not a good choice of fluids. There are times when D5 would be appropriate, for example, if the patient suddenly became hypoglycemic. Otherwise, your overwhelming need to put the patient in a hypeglycemic coma is not a valid indication.

-If the patient requires pressors to maintain an acceptable blood pressure. Pushing beta blockers every six hours concurrently to slow down the heart rate is contra-indicated. There are times when tachycardia is a blessed thing.

-Bolusing patients with two liters of normal saline may not always be the best pre-op strategy, especially in those patients who have congestive heart failure. You may want to consider dialysis patients along these same lines.

Of course surgery has its perks. For example, every surgeon I know gets to ask his/her patient if they’ve “passed gas” yet. I think that’s wonderful. They have a license to ask patients if they’ve farted. Even more impressive, farting is good.

A day will come when internists will no longer need to apologize for inquiring about flatulence.