e 3 a s h i g R E F L E C T I O N S

Call The Cardiologist, NOW!

Few weeks back, I was asked to see a patient in our hospital Emergency Room at about 11:00 PM. It was one of my busier oncalls and after tearing myself away from the wards, I headed to ER. My patient had a number of his relatives by his bedside and as is sometimes the case, each gave a different and conflicting account of what has really happened. The old Papa (as some of my Asian colleagues like to call older patients) had cellulites (an infection of the skin) but due to conflicting history and difficulty doing a meaningful examination, I could not rule out DVT (a clot in the deep veins) so I figured I am going to admit the patient, start him on antibiotics for his infection and scan his leg for a clot in the morning. I explained everything to both patient and relatives and sent them upstairs to the ward. They seemed happy.

Half an hour later, I got a call from the duty manager. Someone has been on the phone to her asking to refer my patient to the consultant cardiologist because “he has a weak heart” and “someone mentioned clot”. I explained the situation and told her the clot we are looking for is in the deep veins of the legs and has nothing to do with the heart. She hung up and half an hour later she called again. Apparently, they have been trying to pressure her to pressure me to call the consultant cardiologist (at midnight) and she told them if they have issues with the medical management, they should call me and talk to me directly. Soon afterwards, I had a call from one of the relatives:

- Hi doctor, I am X (job description), and I am calling about Y (the patient), why are you refusing to refer him to the consultant cardiologist.

- Because his problem have nothing to do with his heart. As I explained to the family earlier, he has an infection and a possible clot in his leg and we are doing everything that should be done for that now.

- But he has a heart problem; he should be seen by the consultant cardiologist.

- I understand he has a heart condition, but this has nothing to do with his current admission and there is no reason for me to get the consultant cardiologist from home to see him. If it would make you feel more at ease, I am going to ask my Cardiology Resident colleague to cast an eye on him.

- No I want the consultant to see him now. I know the consultant personally and he would not mind, and I also know Sheikh X.

- If you know the consultant cardiologist and feel he would want to see your father at this time, feel free to call him and ask him to come. Why are you asking me to do that? I have no justification to drag him to hospital at this hour of the night.

- Your Bosses would not be happy to know you have not called the consultant cardiologist when I asked you to.

- I assure you, I am doing what should be done to the patient now. If my boss wants the cardiologist to come and see him, he will have to call him himself because I will not. In any case, you can go through the duty manager to speak to my boss.

*CLICK* (He hung up the phone)

I went back to speak to the relatives and found that the person who called me was not even one who bothered to come with the patient to hospital and was probably trying to make up for it. They apologised for his behaviour and were grateful for what we were doing. Next day we scanned the patient and he did not have a DVT so we discharged him home and it was a happy ending.