Sunday, August 28, 2005

Unnecessary ICU Referal.. Taking the easy way out..

I am really pissed off at times when I am really busy (sometimes can be damn busy that I don't even have time to sit down ..) and receiving these annoying "unnecessary" referrals to ICU.. When I am too busy I can be sarcastic (definitely not to the patients but to the doctor who made the unnecessary referral)

Aiyks... I was on call on ICU that day and received a phone call referring a case to me... This patient has just undergo some minor surgery under spinal anaesthesia 2 hours ago, and now she has fever with chills and rigor.. Upon further questioning to the doctor who referred the case to me on the phone, the patient was actually very well, comfortable, alert and conscious,(no deterioration in conscious level) breathing well under room air(not in respiratory distress or tachypnoea and doesn't require any oxygen supplement), with stable vital signs.. normal blood pressure(not hypotensive, and didn't require any inotropic support), normal heart rates (not tachycardia).. except she is having fever (which is no big deal.. Post op febrile reaction is common... ). Patient is already started on iv antibiotics..

I don't know what the heck they want to refer me this case for.. What they expected me to do? I asked the medical officer who referred me the case what he wants me to do or what he expects from me after I review the case.. He couldn't answer the questions I asked him, just mentioning that he speaks to his specialist about the case, and the specialist want the ICU doctors to go and have a look.. This is really unnecessary referral... I''m not going to offer anything to the patient since she is too fit to be admitted to ICU. Moreover it's just fever post op which can be managed easily in the normal ward. He can definitely manage to case himself. He think I am very free and have nothing to do??? They shouldn't refer every small matters to ICU people!!! More and more people are actually getting the easy way out by referring to ICU whatever things that they unable to do themselves or don't know how to do/what to do and then "wash hands". I myself have lotsa things to do as well, and my main priorities are to my patients inside ICU... I can't be running around all over the hospital to manage every patients.. Crazy !!

Lately we are getting to many of these unnecessary referrals, increasing our workloads unnecessarily.. More irritating things are getting referrals to set branula and central venous lines or even to the extend of inserting nasogastric tubes for patients on ventilator in the wards.... These are some basic procedures that every doctors should know how to do and it's nothing difficult. If I'm free, I will oblige (provided they themselves have tried it several times and couldn't get it).. If not free, like what my other colleague in the same department mentioned : "Ask them to "fly kite" lah.." They have so many peoples/medical staffs in the ward, ranging from several house officers, few medical officers as well as few specialists.. I don't believe none of them can perform the procedures.. These things are not so difficult to do anyway... Some of them even don't bother to try themselves first and refer straight away...

Just like when I was busy that day when on call in ICU, I get a referral for setting up central venous lines.. The doctor who referred the case to me tell me he has attempted but failed.. Well, I asked him back; has he sought for help from the other doctors in the same ward or from his specialist(s)? They have so many doctors in charge of one ward.. I don't believe there's no one there to help him. Instead of taking the easy way up and push everything to me/doctor in ICU? I'm busy as well, and I have lotsa things and procedures to do in my own ICU, and taking care of so many critically ill and sick patients. And furthermore, I don't have HO or house officers to help me or assist me.. Everything has to be done on my own..

Some even better, when I go there to help them to insert the central venous lines, the person who referred the case to me was not around (heard from the nurse, he went back to his on call room already, sleeping I presume... ). At least have the courtesy to assist or learn lah if they don't know how to do the procedure properly.. I'm not born with all these skills and abilities or experties.. All the skills that I have now, I don't obtain it with the easy way.. I learn it through experiences and through regular practices.. There's no easy ways out...

Another irritating thing... when patients who are on ventilator in the ward collapsed, some of the nurses/junior doctors inform the ICU doctor as well... Hey, come on lah... there are few doctors in charge of every single ward in the hospital and there are doctor(s) on call there as well. What the heck they want to inform us in ICU? I frankly asked them "Do you know how to do CPR (cardio pulmonary resuscitation)? If you know, then go ahead and do CPR, if u don't know how to do CPR, call your senior MOs to assist you!".. I only have a pair of hands and I can't be running all around the whole hospital to resuscitate everyone. And of course there are exceptions as well, regarding the new cases in A&E or emergency unit who are unstable and needs help in resuscitation or intravascular access, then we will surely help to resuscitate..


LT said...

Rightly said and very nicely putting it. :) I feel what u felt!

I also have another problem of some of my bosses admitting patients who are too ill to be benifited from ICU, occupiying a bed and a ventilator for days and weeks ended up still die! By doing so,we are actually just prolonging the sign of life and together with the suffering rather then helping the patient! And some other patient who really needs ICU get denied the chances of ICU care due to no more beds available. NUTs!

Sharl612 said...

Relax Doc. ;-) May I know if a person can request that he/she be admitted to ICU?

Chen said...

yeah.. I understand how u feel and indeed I have the same feelings as well.
Over here, if there are better prognosis cases out there, we will transfer the poor prognosis case out to the ward for ventilatory support in the ward.

I don't understand some doctors in the ward intubating poor prognosis cases with GCS 3/15.. and yet our ventilators are so limited.. Intubating this sort of cases will just prolong their sufferings only since the prognosis is so poor.. and denied the others with better prognosis who needs ventilatory support :(

In government hospital, the doctors in ICU will decide which patients need ICU care. We don't practise discrimination over here.. There's Indonesians, Burmese and people with all sort of nationalities in our ICU despite limited beds. We will admit in cases which needs intensive care monitoring if bed is available. However priorities are given to those with better prognosis sinces bed is limited, and most of the time, our beds are fully occupied..

And of course if in private hospital, then different story loh.. :)

vagus said...

yup, ca definitely empathize with that

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