Saturday, 19 April 2008

Musings of the sleep deprived

POSTED BY Dr Thunder.

It's a short post this week, as I'm on night shift. That means I'm:

A) Too tired to blog properly

B) Too incoherent to blog properly

When you're on nights, things annoy you, way out of proportion to their importance in the grand scale of things.

For, example, the subject of my whineing on his paricular run of nights is the rather grandly named "lactation consultant" who visits our neonatal unit on occasion.

Now, I'm not sure what exactly a "lactation consultant" does. I know she wears a power suit and talks to mums about breast feeding. I'm not 100% sure why we need her. She looks expensive. From what I can work out, she's a nurse who has some extra training in breasfeeding. So she's there to pass her wisdom onto our new mums. Our excellent nurses in NICU talk to our mums about breastfeeding too. They don't call themselves "Looking after sick baby consultants". I suspect she earns a lot more than them, too. She is, of course, unavailable out of hours.

Anyway, it's not the lack of a freely available job description that has me riled. It's the rubbish that she writes in the notes. Why is it that anyone with the title "consultant" in their job title* thinks the whole world is interested in every minute detail of their "Client episode"? The reason I'm saying this is because our lactation consultant has seen 3 mums today. In each case she has written in the notes "I have empathised with (patronisingly insert the patient's first name, which she uses without asking if that's OK) regarding her sick baby".

I mean who writes that they have empathised with the parent of a sick child?? There is probably an "empathy pathway". There may even be an empathy facilitator, who could be called in for a referral.

*sadly, the exception here are my medical consultants. About half of them never write in the patient notes. They expect the resident (junior doctor) to document their decisions. This is becoming more widespread in my opinion, and I find it very unprofessional. For all the faults in the UK service, our neonatal consultants used to see every patient every day, and write a full plan for every patient every day. Here , in about 50% of cases, the ward round consists of a consultant asking the registrar a few questions, telling us what he wants to do, while the poor junior tries to transcribe his/her ramblings. Your decisions.....your far as I'm concerned.

The final thing that's been pissing me off is getting the blame for stuff that ain't your fault. EVERY doc has been in this boat.

This week the senior registrar came to review a very sick patient that I was looking after. He changed the kid's intravenous fluid regime. Sadly, he didn't bother to write up a new fluid order. The nurses are pretty good when we're busy and are usually happy to take verbal orders, within reason. So, the boss noticed on the ward round that the new fluids hadn't been written up, and proceeds to tear me a new arsehole.

I didn't even know the fluid regime had been changed!!!!

I assumed I'd made some kind of a cock up, so I just toook the abuse. I am absoloutely 100% against the idea of ANYONE in the hospital environment (or in any environment) raising their voice to another member of staff, regardless of the circumstances. It's, essentially, illegal, and rightly so. But sometimes you've got to take it.

The senior reg was in no hurry to offer up the fact that it was his cockup.

Then the next day I was on the morning ward round after the night shift. I basically tell the day staff what has happened to all the kiddies overnight, just before I go home. As I was discussing a baby, one of our nastier consultants asked me "has this kid has her MRI yet?".

"No, she hasn't".

" rant rant rant rant blah blah blah this is totally unacceptable Dr. Thunder blah blah blah" basically ripping into me. This is becoming a recurring theme.

Now, I'm just the night shift guy. The day to day routine management of this patient isn't my responsibility. That's the responsibility of the daytime team. At night we are running on minimum staff, so we only deal with acute problems that arise. We're not expected to do the routine work. It's just too busy for that to be an option.

I explained this as best I could. It's unit policy, so surely he'd understand?.....

His response.......

"Blah blah blah it' unacceptable Dr Thunder blah blah blah completely unacceptable".

Jesus christ.

The actual team who were looking after him stood beside me in silence. Wouldn't want those references being compromised, would we.

Why are hospitals full of people like this? Answers on a postcard please......


  1. Ugh, that's so not cool... Sorry you had to deal with that :(

    On a happier note, isn't it registrar changeover time soon? New department = happier Dr Thunder perhaps?

  2. That's true Polly. No long now. But in fairness. i do overall like the department I'm in. I jus get crotchety when I'm on nights, so I focus on the bad things :P

    Next week's post will be about pretty meadows and spring lambs :P

  3. Understandable! I'd get cranky on nights as well!

    What department are you off to next on your travels??

  4. In the next year or so I'll be doing a mixture of general paediatrics, paeds emergency medicine, and a little bit more neonatology. Hoping to give the neonates a bit of a rest for a while, to sharpen up my paeds skills in gerneral, so should be a fun year.

  5. You sound in need of an 'empathy consultant' to me ;-)

    Good luck with the rest of the week!

  6. Ahh, I rememeber those junior days. All funs and games, you will look back on this with a wry smile one day Im sure!!

  7. Went for coffee with a friend last week and following on from your "Lactation Consultant" I overheard a group of breast feeding ladies talk about themselves being "Lactivists" - actively breast feeding. Thought it was funny.

  8. PhD married to MD29 April 2008 at 21:44

    Tough luck Dr T.

    My other half used to get a fair share of this kind of thing when she was a staff grade reg managing an MAU in the daytimes (UK teaching hosp). The junior doctors from the medical teams who "owned" patients on the MAU would try their damnedest to avoid coming down and seeing the patients (why should I come to the MAU when a non-training grade numpty tells me I should etc etc). Same juniors would then later disclaim all responsibility ("oh I wasn't told it was serious enough to come down, the MAU person never made that clear") if their consultants started asking questions or ranting and raving. The point was that they didn't want to come down to the MAU if it meant losing chances to stand as beneficially near to the boss as possible.

    It was hearing about stuff like this over and over that made me understand the rifts in the UK between training post and non-training post doctors.

  9. LOL at "lactivists". Quality.
    The point is being made over at that there is no specialised help available if you're a "bottlist". It's one of my great bugbears.
    Breast feeding simply doesn't work for some people. Those people who have trouble with other feeding methods should have access to specialised help.

    PhD married to MD: there's a lot of discrimination against staff grades and other non-training grades in hospitals in the NHS. Seems bizarre to me. Some of these guys are amongst the best docs I've ever worked with. I think there's an assumption that they couldn't hack the career ladder, and are therefore somehow inferior docs. But the last 2 I worked with were amazing. One had taken some time out for health reasons, but would easily have made it to consultant level. The other guy was incredibly talented (and had both his adult and paediatrics exams!), but he was planning on going abroad permanently in a year or 2, so couldn't be arsed going through the ridiculous competition for places on the training programme, when they could send him anywhere in the country. Why not just get a stable contract in one hospital.