perplexed doctor

Intern Determined Not to Have Medical Decision-Making Capacity

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ANN ARBOR, MI – For several days medical intern Brent Hammock appeared very confused.  He had lucid moments now and again, but he was usually in a daze.  He was disoriented, agitated, and combative.  He was clueless.  More often than not, he responded only in one to three word answers, if he chose to answer questions at all.  Family members were concerned that he was different.  So were his colleagues.  Nurses questioned his judgement and finally brought it up with Hammock’s team: he was altered and becoming a danger to himself and others.  For that reason, Donna Rice of Psychiatry was consulted.

32445044_mToday Rice made her final assessment and it’s official: intern Brent Hammock does not have any medical decision-making capacity.

The outcome does not come as a surprise to anyone.

In an excerpt from her lengthy consult note, Rice summarizes her assessment: “Medical intern Brent Hammock clearly does not show adequate reasoning or understanding of the risks, benefits, alternatives, or consequences associated with his decisions, particularly when it comes to the practice of medicine and the diagnosis and treatment of disease.”

Shawn Torres, a patient of Hammock’s admitted three days ago for congestive heart failure, called Rice with the consult.

“I felt Dr. Hammock was out of character,” Torres explained from his hospital bed.  “When I asked him why he was giving me 400 mg of Lasix even though I was in renal failure and hypokalemic, he blushed and said ‘Ummm’ and ‘Well’ a lot and kept clicking his pen nervously.  Then when I asked him if I could take a shower, he never responded.  I just… I just don’t think he knows what he’s doing.”

Rena Damien, Hammock’s senior resident on wards this month, agreed with the consult.

“I first thought about calling Rice when he treated hyperkalemia with potassium,” said Damien, shaking her head in disbelief.  “Just these past few days alone, he has misplaced his stethoscope, mistaken insulin for aspirin, gone into an airborne isolation room without a mask, ordered a stat social work consult for placement, and fallen asleep during a spinal tap he was performing.  Did I mention he once ordered serial chloride levels?  Chloride levels.  I’m glad Rice was called.  It was time.”

Charge nurse Betty Thomas offered this observation on Hammock: “Every time his pager went off, he became incontinent and cried.  He thinks he’s a doctor, poor little thing.”

Hammock started on inpatient wards five days ago and this is his first ward month as a physician.  Torres, Damien, and Thomas are just a few of the numerous patients and colleagues who have noted Hammock’s change in mental status and behavior.  He stopped shaving and showering.  He was disheveled.  His white coat was covered in coffee stains and his pockets were filled with never-ending sheets of folded paper full of illegible and incoherent scribble.  He never knew the answers.  Worse, he never had any questions.  In a matter of days, many people realized that Hammock couldn’t make medical decisions on his own and that someone needed to step in.

“It was the right thing to do,” said Hammock’s attending and newly appointed medical power of attorney Justin Lane.  “He needs to get well.  I promise I’ll do my best to make decisions based on how my intern would think and act if he were in the right mindset and could manage diseases like a competent medical provider.”

Hammock’s case has set a precedent regarding the care of patients by interns.  Within hours of Rice’s official assessment, her pager and phone lit up with a record number of new consults, all with the same clinical question and request.

“Nurses, attendings, patients, families, they want every intern evaluated for capacity, irrespective of their specialty,” replied Rice, her consult list growing exponentially.  “It’s a lot of work for me but hey, can I blame them?”  Rice goes on to explain that she would have had help this month on consults, but recently found out that it was in the form of two brand-new interns.

Needless to say, Rice has chosen to work this month solo.

As for Hammock, he has been placed in a room across from the nurse’s station for closer monitoring.  He has a Foley in place.  For now, he has a one-to-one sitter, with restraints, Haldol, textbooks, and UpToDate ordered as needed.

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  • Show Comments

  • Avatar
    Steven H. Brown

    Charge nurse Betty Thomas offered this observation on Hammock: “Every time his pager went off, he became incontinent and cried. He thinks he’s a doctor, poor little thing.”

    Awesome

  • Avatar
    Adam Smalley

    Don’t hate.

  • Avatar
    Andrea Jungwirth Lams

    I hate to admit this, but I was that intern in 1969.

  • Avatar
    Penelope Benny-José

    I think something like anatomical pathology might be better…

  • Avatar
    Kate Brennan

    Steph Jessup

  • Avatar
    Conni Errickson Miller

    I thought this was supposed to be a satire… ;)

  • Avatar
    Jennifer Pippin

    Karen Daniels – “ordered serial chloride levels” bwahahahahahahahaha does this sound like anyone we know?

  • Avatar
    Drew Oliveira

    Internal medicine or radiology for this guy

  • Avatar
    Quinn Katherine Lancor

    God I’ve never seen a more accurate inaccuracy of an article!

  • Avatar
    Rana Whitney

    We all work with that guy. Especially on nights. They never want to make any decisions. “Let day team decide”

  • Avatar
    Jodi Faulkner

    One of my attendings

  • Avatar
    Chananya Goldman

    Finally we interns get some attention from Gomer! Hahaha

  • Avatar
    Chris Jones

    There’s days that every doctor is that guy. Everyone needs help some days.

  • Avatar
    Emma Grullon

    Quinn Katherine Lancor!

  • Avatar
    Vadim Korkhov

    Sadly, a deficit not limited to interns

  • Avatar
    Jose Maria Julian Roggen

    So much work so little time, so much work so little time, so much work so little time….

  • Avatar
    Valeree Gold Stout

    Uh, uh, let me call my higher up….I hate when they say that! Just order what I am asking for.

  • Avatar
    Kelli Gregg Maddox

    Poor little thing thinks he’s a doctor!

  • Avatar
    Ming Jang

    Hahahahaha

  • Avatar
    Mandy Bollen Barclay

    Just don’t make that face Alan. Lol we are all that guy some days.

  • Avatar
    Alan Altham

    I’m worried some days I am that guy:p

  • Avatar
    Bill Clark

    I hope he never meets Dr. clinical correlation advised from Radiology.

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