Last week I met an old resident in the corridor. She was once an excellent intern, and is now sitting her physician’s exam. You can’t win ’em all, I suppose.
We should have spent our three minute conversation talking about her exam, my kids, or our non-medical lives. Instead, she had to debrief about a surgical registrar. He was trying to turf an elderly urinary-retented gentleman to her medical unit. Classic urology response – catheterize and TURF.
Now, everyone knows this happens. Surgical units like to deal with acute problems, and feel “tricked” when the patient stays clagged in their hospital bed with ongoing medical problems. In my hospital, there is an understanding that these sort of patients are better managed by a medical team. But why do we have to forget it is a favour? Patients aren’t library books to be returned, and they aren’t trying to trick us either. Our responsibility doesn’t dissolve when we finish what we are good at and enjoy.
I plan to continue to TURF, whenever I can and need to. It is a game, it is a puzzle, but it is not a war. I prefer to think of it as a conversation:
SURG: Would you take my lovely man with cardiac failure, and reduced hernia?
MEDICAL: I think you need to fix his hernia. That is his primary problem.
SURG: Oh. Woe is us. We would love to fix his hernia, but are worried that we are neglecting his early hospital-aquired pneumonia because we are barbers, not physicians.
MEDICAL: I have been trumped again. What you say is true. I will take Mr Hernia, if you take Mrs Feeble Recurrent Volvulus.
SURG: Of course. We may be able to convince Mr CR Surgeon that she presents a unique surgical challenge.
See? Fun, and part of the fabric of medicine. This is the way the “hospital free market” ensures patients are well-looked after. But please, no matter how tired you are, or how tired your standard “wall-phrase” becomes, it is always more fun to win with wit than brutality.