Medicine Consulted for History and Physical
IOWA CITY, IA – The University of Iowa Orthopedic Department has gone “all-in.” At 13:36 on Thursday, Orthopedic Surgery finally took the plunge from the on again off again relationship with Internal Medicine to a full symbiotic relationship.
Bill Hutchins, the Orthopedic Surgeon, consulted Medicine for an H&P. “I called them to create my history and physical,” said Dr. Hutchins. “Internal medicine couldn’t be happier. Plus I don’t think Internal Medicine is allowed to turn down consults or take primary on the patient.”
Sometimes Orthopedics will consult Medicine for hypertension management on a patient that has one medication, hydrochlorothiazide 12.5 mg. Other times if the patient has type II diabetes and is on metformin, Medicine will be consulted to hold the metformin during their hospital stay and maybe sign the insulin order set for a possible sliding scale. If Internal Medicine gets lucky they will be able to dictate the discharge summary, because once the surgery is over they are no longer a surgical case it will have “morphed” into a Medicine patient.
“Yeah, let’s just call it what it is. We just want to cut bones. Medicine wants to do medicine so we’ve separated ourselves from anything resembling ‘mediciny.’ Asking for a full 9-system review of systems, well, I don’t think I could name 9 systems in the body,” Dr. Hutchins told reporters, although he did continue to try by counting fingers, but he didn’t make it past his first hand.
“Let’s see bones, um, the system the ribs hold into place, ah… the system between the pelvis and the rib cage, OH! The one inside the head bone! Yeah, and of course there is the blood system, which feeds the bones 2 grams of Ancef for surgery. But we all know the bones make blood so really it is part of the bone system.”
Hutchins went on to say, “Have I told you what the ABCs are for orthopedic surgeons. Ancef, Bone, Cut! Although I guess it is now CAB which works for me. I love to cut.”
When the Medicine resident was questioned, he was ecstatic, “I love doing H&Ps! When I get home I make up stories for TV characters, my wife, and even my daughter’s dolls and I will sometimes go on an all-night bender of H&Ps.” Dr. Brenson went on, “I have some great H&Ps on Sookie Stackhouse from True Blood,” referring to all the injuries and transfusions she has received.
“Except Fridays. Fridays I do discharge summaries for all those pretend patients, because if there is anything is better than an H&P it’s a discharge summary. Discharge summaries are like recapping an exciting TV episode of Game of Thrones or House of Cards, except they are WAY more exciting.” The excitement was palpable.
This resident is no exception, in fact in a recent ACP survey showed the number one reason to go into Internal Medicine was discharge summaries, followed by H&Ps and social admits.
Other Orthopedic residents were overheard talking about the icing on the cake move in getting the Anesthesia Pain Service (APS) to follow their patients. “Yeah, if we get Medicine to write orders and H&Ps for us and top it off with the APS taking care of pain, all we have to do is cut and fix bone. Lets go hit the gym and write more clinical studies talking about how we are strong like Ox!”