Hi, I Have A Ludicrous Referral For You

I’m settling into my new job as the surgical F1.

The way I can tell that I’m working with surgeons, who are turning out to be unexpectedly lovely, is that sometime between medical school finals and FRCS, some of them, no matter how lovely, have clearly given themselves a common sense-ectomy. To wit, the instructions I was given on Monday on the ward round vis a vis one of the very well elective patients who was almost ready for discharge.

“Beth, this man had a heart rate of 90 when he was assessed in pre-op and he had a heart rate of 90 during theatre and he had a heart rate of 90 when he returned to the ward post-operatively and now he still has a heart rate of 90.”

Okay.

“His ECG has been normal.”

Okay.

“His other obs are all fine.”

Okay.

“So, I got the F1 who was on the ward last week to check TFTs. If those are normal, can you refer him to medics for cardiology assessment, please?”

… Wait. What?

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8 comments

  1. My two worst referrals ever, in reverse order:

    “This lady with epigastric pain and a normal AUS/OGD has got a cough. She has been smoking for 50 years and the nature of her cough has not changed for a decade. Obviously she has pneumonia and this is what is causing her pain. Refer to respiratory.” No. I got out of that one by doing a CXR and proving that she did not have damn pneumonia. She had ischaemic colitis.

    “This lady in her 30s has altered PV bleeding and discharge. Refer gynae.” She. Had. Her. Period. And the urology registrar, who was clearly not a man who was familiar with vaginas, made me actually phone gynae. I have never been so embarassed in my life.

    • I am not a woman who is familiar with penises, but I’d like to think that I will not in the future try to make my F1 refer men whose only fault is having one to urology…

      • I’d like to think that you at least have some idea of the basic anatomy and physiology of the penis. This man appeared not to have encountered the concept of female reproductive parts before.

  2. Last week one of the other FY1s in surgery was on the ward round discussing a patient with what we suspected was factitious leg shaking. The conversation went like this – “Is there a neurologist in the building?” Not on a Tuesday. “Is there a rheumatologist?” Yes… “Refer her to them please.”

    What?

    • It’s this sort of thing that makes me grateful to have opted to do surgery last. At least by now I know all of the medics well enough that the next conversation doesn’t go, “Hello, this is one of the surgical F1s, please don’t yell, please don’t yell…” but, “Hi, it’s Beth, look, I know this is a stupid question but you don’t need to actually come and see them and please bear in mind that I’m not actually the one asking it…”

      • I love those phone calls. “I know this is stupid, please can you just formally refuse to come and see this patient?”

  3. Having been the medical resident on the other end of those phone calls so many times, this makes me want to scream. My personal favourite consult was an endocrinology consult at 5 PM on a Friday from the obstetrics ward for a woman who had been tachycardic her entire admission and now needed to go home. Her TSH was over 20, and the question for us was “Is she tachycardic from hyperthyroidism?” I initially wrote “No” on the consult and walked away, but then felt the need to expand a bit in the interest of the patient not dying from sepsis or profound blood loss in the hands of the obstetricians.

    • The flip side of it is that I’m expected to make these idiotic referrals to the medics (and, dammit, I am the medics, it’s not my fault that they’ve sent me to flounder on a surgical ward for four months), but, when I referred someone to the surgeons, admittedly at 3pm on a Friday, but, you know, she had had been admitted with cellulitis and that was the first time we had properly been able to see that her toes were actually purple, they sighed and huffed and puffed and this-is-such-an-inappropriate-time-for-a-referral-ed and do-we-really-need-to-see-her-tonight-ed. And when I said that I supposed they didn’t need to see her tonight but that they did need to see her before Monday, I was told that I was “very bolshy for an F1”.


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