PORTLAND, MA – Hospitalist Dr. Doug Moore was trying to plan ahead for his upcoming weekend. He knew he had to take Ms. Williams off his list to have a completely free weekend. Dr. Moore tried to plan out his day so that at 12:00 PM, without seeming like he was dumping the patient off, he called surgery. Here’s how the rest of the day’s events transpired:
12:03 PM – Dr. Moore calls Dr. Wilson, a general surgeon. “Hey Bob, I have a patient here that I think you need to take primary on. She’s a 43-year-old female with abdominal pain and you took out her gallbladder last March. She mentioned that she would like to see you.”
12:47 PM – After Dr. Wilson unknowingly took primary, he saw Ms. Moore, realized his weekend would be extra busy, and then called gastroenterology to transfer care. “Yeah Rebecca, Bob Wilson here. I have a patient here that I really don’t have a surgical option for at this time. You may want to scope her.” Before she could tell him “No” he hung up the phone, a typical surgeon trick.
1:55 PM – The gastroenterologist, Dr. Shriver, realized she would not be able to perform a scope until Monday, and couldn’t justify an emergent scope on a Friday for vague abdominal symptoms, so she called nephrology. “Hey Chris, I have a patient here that is a stage 3 CKD, and is having what seems to be kidney pain. I’d like for you to see her. There really isn’t much more we can offer from a GI standpoint.” When reminded that nephrology didn’t take primary, Rebecca informed Chris that she inherited this patient from surgery. Chris agreed only because she brought in fresh-baked delicious cookies today.
2:21 PM – Dr. Chris Carpenter, the nephrologist, realized that this pain wasn’t from her kidneys, but couldn’t be certain, because the radiologist read of the CT stated that she had a calcified kidney. Seizing the moment of clinical correlation he called the urologist to hand her over. Knowing that it was almost impossible for a urologist to take primary he had to be tricky. “John I need you to write this down…” after giving the medical number and the history of “possible stones” he quickly said, “I have nothing to offer and I need you to take primary.”
The quick hand-off trick didn’t work for Chris this time; so he had to rely on an old rivalry and reverse psychology. Dr. Carpenter called cardiology. “Hi Dr. Clemens, I need you to take a patient for me. I gave them too much fluid and now they are in heart failure.” Hook, line, sinker, Dr. Clemens was so excited that nephrology was conceding on fluid management that he took the patient. Once he finally realized it was a trick, he remembered John, the urologist, owed him. In the hallway he convinced him to take the patient from him, thus freeing up his weekend.
3:56 PM – Urologist calls the hospitalist, Dr. Doug Moore, “Hey I have a patient that supposedly has kidney stones, I looked at the scans myself and I didn’t see anything urgent. I’ll need this patient to have medical care this weekend until I can schedule her for the OR on Monday.” When asked how he felt, Dr. Moore told reporters, “Well it was a good effort, but unfortunately I won’t be able to go to the lakehouse this weekend.”