One Way to Get Burned

Rachel's former employer

As people who take home call, i.e. we don't sit overnight at the hospital waiting for people to page us, we have to develop good working relationships with the people who frequently consult us in the middle of the night. This is primarily limited to the ED physicians and trauma team - with whom, overall, I have developed good relationships. When one I really trust calls me and relays to me what is going on, I can pretty much take it as truth and make immediate clinical decisions. I will discuss in a later post those instances in which what I'm told can be taken as nothing more than pure fiction.

I give in specific the case of orbital fractures. In a given week, we see these more times than I have ever cared to count. And for the most part, barring any catastrophic globe injury, there is nothing emergent about the fractures for us to address. So when a trusted ED physician calls with a routine orbital fracture and tells me the vision and pressure and eye exam are essentially normal, I feel comfortable having the patient follow up in the clinic the next day without an immediate visitation by me. In the private world, this is how it routinely happens. Of course in academics, it's rare that one would try to do this, but I was going to give it a shot. It had been done successfully in the past by others.

The clinic visit comes and goes, and the patient doesn't show up. You may note if you're a frequent reader, I have talked about this before. My heart pounds up into my throat and I wonder if I have made a mistake by not seeing the patient in the emergency room when I had the chance. I call the patient, but of course the available phone numbers are not connected. Ass.

This is how you can get burned. Thankfully, he showed up two days later, thinking that was his scheduled appointment, and everything regarding his eyes truly was okay. But talk about a moment of clench. I am sure clench moments will be much more warranted as I become more experienced in my training, but the simple thought of a program director yelling at me if a patient was lost and had a complication is frightening.