Psychiatry Residents Estimate that 30% of Consults are for Comatose Patients

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Dr. Charles Willis scowls at his beeping pager for interrupting his lunch break. “Christ almighty, I can’t sit down for a couple hours without this damn thing going off,” he grumbles, hauling himself out of the massage chair in the first-floor residents’ lounge. He heads for the cafeteria, hoping to buy himself a coffee and a little time before taking the long way to the medical floor.

As a fourth-year psychiatry resident, he usually gets stuck with the consults from medical or geriatrics, most of which are requested by over-zealous medical students. “Take the one I had last week,” Dr. Willis says, strolling down the halls with his coffee in one hand and smartphone in the other.

“Some dumb M3 writes ‘rule out selective mutism” on the consult sheet. I got a little excited, because, you know, that’s easier to handle than the borderlines that show up in emerg every ten minutes. I go up to geriatrics and lo and behold, the guy’s just deaf, blind, and completely demented. Total waste of time.”

In a practice as old as time itself, every department tries to turf difficult patients to the inpatient psychiatry floor. As Dr. Willis explains it, “If you cry because your congestive heart failure is ruining your quality of life, they want to send you to psych for major depressive disorder. If you refuse too many meds, you’re clearly psychotic or suicidal. All the overweight patients suddenly have binge-eating disorder. The list goes on.”

Arriving at the nursing station on the medical ward, Dr. Willis inquires about the patient in question. “Yeah, I just got him today, so I don’t really know much about him,” says the patient’s nurse. “I’m pretty sure he’s catatonic, though. Anyway, I’m going on break, so maybe come back later if you need to tell me anything.”

Dr. Willis sighs and flips through the patient’s chart before heading into his room. He re-emerges twenty seconds later, scrawls a one-liner on the consult sheet, and makes his way to the elevators. “The guy’s in a medically-induced coma for alcohol poisoning,” he says. “Of course he’s not talking.”

On his way back to the lounge, Dr. Willis notes that a typical Sunday may yield up to three such consults. “They’re really making me work for my money today.”

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