Life on PCLS (psychiatry consult liaison service) at NNMC (National Naval Medical Center, known in the Army Medical Corps as "Navy" and in most of the world as "Bethesda") is very slow. It's been a week, and we've had a total of three patients, for three interns. One of them, my patient, had a history of depression and anxiety and had been admitted to the hospital four times in three months with abdominal pain, that the medicine and surgery teams had completely worked up and couldn't find a medical cause for. So they consulted us to see if there was a psych component to her complaints. I chatted with her for about an hour, presented to my attending, and we recommending increasing her anti-depressant (she was on a pretty low dose) and following with a psychiatrist after discharge. Done and done. One of the other two patients that we had was just as simple, and the third, the only one we were seeing for more than a day, was a retired Marine colonel with chronic pain (from combat wounds), who had been taking a lot of narcotic pain meds and self-medicating with alcohol. He pretty much admitted himself for detox, and we had been making recommendations for detox/withdrawal and following with him until he could get into an actual rehab program.
So, what do we do the rest of the time? Well, a lot of sitting around the intern room at NNMC and being made fun of by the surgery interns, who were actually doing work (and we mock them in return for having to do work), and dodging inappropriate consults. We've actually only had two of those: one from a surgery resident who had a patient coming into clinic. The patient had a pretty complicated post-operative course, with a lot of chronic pain issues, and had a lot of anger, so the resident wanted someone to come by to the outpatient clinic and talk with her. Well, we don't see outpatients (just inpatients and in the ER), and besides, how would you feel if you came in for your post-op appointment and saw a psych intern sitting there wanting to talk to you? So we told her that if there was nothing acute (suicidal or homicidal ideation, etc), that she should talk to the patient and find out if she wanted to talk to mental health profession, and if so, put in a referral for her to see a psychiatrist/psychologist as an outpatient.
The other one, and I felt sorry for the intern for this, because I could tell it wasn't her idea, was on an ICU patient in a coma, who had a family who was being difficult to the ICU nurses and docs. Patient relations and social work was already on board, but the attending "wanted to cover all the bases". So I asked what the PCLS issue was, and the intern said, "Well, there's some question about whether or not they can make decisions for the patient." I asked if they wanted capacity evaluations for the family, and the intern said no, that's not what they wanted. So I told her that I didn't think it was something for us to be involved in (especially since they already had patient relations and social work involved already), but that I'd talk to my attending about it and get back to her. Well, my attending laughed and said that we don't see the families of patients, no matter how much they're annoying the primary team. I did apologize to the intern when I told her we weren't going to see family, and explained that I don't want her to think we're dodging work (especially since we weren't doing any), but that it really wasn't an appropriate consult. She thanked me, and that was that.
In all, I went from working ten + hours a day, six days a week (plus being on call) for two months, and now I work about six hours a day and get weekends and evenings off. It's weird, and I'm trying to get used to having down time again. I've been running more, and since NNMC has a pool on base, have been swimming a couple of miles a couple times a week. Life is good.
No comments:
Post a Comment