Timing is everything
Research has shown that overall, you get better care at a teaching hospital. However, in one of these two cases that I mentioned in the previous post, I wonder if being at a teaching hospital was detrimental. Not because we the residents didn’t know what we were doing. Even I, the intern, knew what was going on with this patient from the second he walked in the door. Rather, I saw the patient, had a good idea what was going on and felt confident starting baseline treatment. But then I had to tell my attending, who had to go see him. He agreed with me, and that surgery needed to be consulted. So I call surgery, and the surgical intern has to come see the patient, she agrees it’s serious, so she has to call her upper, who has to make his way down, who also agrees it serious, who then calls HIS chief resident, who has to make his way down, who then agrees it is also serious, who then calls his attending, who has to make his way down, and finally agree that its serious and needs to go to the OR. I don’t know if in the long run it would have made a difference, as this patient was pretty sick to start with, but in time sensitive cases like this one, about 50 minutes was spent “running it up the chain”. It would be sweet if there was a trauma level response option for non trauma cases. I realize that the logistics of that would make life damn near impossible for the surgeons, getting their who team mobilized every time an ER doc thought that a patient had a case that he suspected to be of the “time is testicle/ovary/gut/brain/muscle” variety.