Everybody's doin' it...

Dr. Sid is doin' it. Dr. Rob is doin' it. And now I'm hopping in, with my own simple rules and few for you physicians out there who want your patients to end up in my ample lap.

How To Have Things End Up As You Would Like Them To: A guide for physicians in our hospital

1. Please be aware that, as you've been told since your first day as a resident, nurses cannot call for consults. If you write an order for a consult, you're the one who has to call the doc. Wandering vaguely away from the chart rack will not accomplish your consult; neither will being mad at me for not calling. No matter how much you yell, this will not change.

2. If you are sending a patient from your office for a consult, please note that our surgeons have office hours. You, as the referring doc, can't just send a person up to the hospital floor with no warning and expect them a) to be admitted, or b) to be seen in a timely fashion. The doc you wanted is probably up to her elbows in somebody's brain and won't be available for at least six more hours.

3. Don't lie to me. Don't call me with the news that you've got a critically ill patient on his way via ambulance for immediate admission. Not only can I not *do* anything about that (you really should call the bed-board people for admissions), but I will be supremely pissed at you when, after a two-hour scramble to get an acute-care room opened up, your critically ill patient shows up walking under his own power, having driven himself to the hospital.

4. Understand that certain things are not our specialty. Let's say that you have a patient who's post-heart/lung transplant and who is having problems. I will do my best to send them to our sister facility, Holy Kamole, because *they* took over all the heart/lung transplants four years ago. It really doesn't matter how much you want them to be at La Schwankienne; we do neuroscience. We don't know a damned thing about transplants. It's not a personal slight; you don't have to holler. It's about the best care for the patient.

5. Having the admitting physician write a consult request for a particular specialist is, I guess, okay. It's not okay when it was your idea, when you're the one who'll be consulted, and when the patient is your mother.

6. And finally--listen up, guys--when you write a consult for an inpatient, be aware that the patient will be seen first by the resident or fellow, and later by the attending (once the attending finishes office hours or surgery or whatever she's doing). This is how it works in *your very own service*. Do not--I repeat, do *not*--get snippy with the charge nurse when the senior resident or a second-year fellow is the first to have contact with your patient. (You know who you are.) I have nothing to do with it; I can't help you; perhaps you should think back over your last ten years here and see if it's ever been different.

Thank you. You may all return to your regularly scheduled rounds. Please do not rack charts with new orders. Thank you. Thank you.