Sunday, February 17, 2013


Once again Great Zs has unlocked my writer's block.

About a month ago our friendly Patients Concerns Office sent me a little letter.   Apparently the relatively of a patient with a fractured hip wrote to complain that her loved one had waited 3 days to have his fractured hip repaired.  Moreover he had been put on the list every single one of those days which meant fasting until he was cancelled late in the evening.  This of course had to be anaesthesia's fault so I investigated.

First I got our head nurse to send me a print-out of every "emergency" case done during those three days.  I suddenly noticed a funny thing.  Saturday, day one of his ordeal was a pretty busy day with lots of ortho and other "emergencies".  Sunday however everything suddenly stopped around 1400.  This was indeed curious as one of the most mercenary orthopods was on call.  I then realized what had happened on this day.  It was Canada's version of the Super Bowl, the Grey Cup and the orthopod wanted to watch the game.

This of course wasn't the reason why the patient waited until Monday night.  The real reason was that his PT INR hadn't come down until then.   As I told the nice Patient Concerns lady, I have told ortho and their hospitalists multiple times NOT to book patients until their coags are normal and we go thru this little dance of booking and then cancelling patients just about every day (not infrequently because somebody forgot to stop their coumadin).

At our little hospital it is possible to predict how busy a day will be just by which surgeons are on call. .  We have the mercenary ortho surgeon above but we also have several general surgeons who bring in cholecystectomies off their wait list when they are on call.  They also book colon cancers as bowel obstructions.  Our hospital has been designated as the kidney stone centre for the region which means when one of a group of 3 urologists is on call, their office will book 4-5 patients.  These patients will come in as "day patients" at around 0900 which means you just can't run off one or two first thing in the morning while everybody else is getting their act together.  Instead the urologist waltzes in around 0930 expecting to go ahead of  everybody else, having booked his cases Friday morning.

Appendixes are another thing of course.  These are never emergencies between 0700 and 1600 on weekdays when it would mean bumping a general surgery room.  At 1600 however a general surgeon will be at the desk demanding that they be done immediately or else they will surely die (that is unless he has a gall bladder or a "bowel obstruction" to do first).

Things are tight, the population is older and sicker and the number of OR rooms hasn't really changed much in the last 20 years so I can see why surgeons might want to play these games.  On the other hand it is when we have a real emergency come thru the door that the shit literally hits the fan and it is usually anaesthesia and nursing who have to sort out the mess.  Not to mention the poor anaesthesiologist slogging away on some real or imagined emergency late in the evening.