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Professionalism is a lost art
I don't get this mentality. If this person rolls in at 706 and the 7a doc shows up at 710, you tell them to take over and you leave. I have no idea why you would stay to manage that patient. Hell, if a total Trainwreck rolls in at 655am, I'm generally giving that patient to the 7a doc as well. That's just sort of understood to be a viable option. Is this actually not an option at other people's shops? Am I just taking for granted that I work with a bunch of other actual adults?Counterpoint: when you're single coverage, it blows staying over for an hour+ dealing with an ICU train wreck admission that rolled in at 7:06 because your relief is late, again, and you had to spend time with lines/tubes/labs/calling...
I don't get this mentality. If this person rolls in at 706 and the 7a doc shows up at 710, you tell them to take over and you leave. I have no idea why you would stay to manage that patient. Hell, if a total Trainwreck rolls in at 655am, I'm generally giving that patient to the 7a doc as well. That's just sort of understood to be a viable option. Is this actually not an option at other people's shops? Am I just taking for granted that I work with a bunch of other actual adults?
Exactly. Even if someone is 5 minutes late, that's enough time to be up to your elbows in an intubation or a line or whatever, and even if you didn't do anything but run the resus until you could hand it over, you still have to document that. So now you're leaving at least 15 minutes late because your colleague was 5 minutes late (5 min running code, 5 min handover, 5 min charting). And inevitably something will come up with your own patients (or new ones) during that time, and since you're physically present, you'll get 3 nurses coming to you with questions/orders/concerns "just real quick before you leave."Yeah, you are.
If you're single coverage and a cardiac arrest rolls in at 0703 and your relief is 20 minutes late because of "traffic", you're gonna be doing some stuff and writing a chart. There's no warm handoff of that.
And inevitably something will come up with your own patients (or new ones) during that time, and since you're physically present, you'll get 3 nurses coming to you with questions/orders/concerns "just real quick before you leave."
Counterpoint: when you're single coverage, it blows staying over for an hour+ dealing with an ICU train wreck admission that rolled in at 7:06 because your relief is late, again, and you had to spend time with lines/tubes/labs/calling consultants/charting and then dealing with worsening traffic on the way home isn't fair so your colleagues can avoid "drinking coffee toavoid ever being lateshow up at their scheduled times like an adult with a professional job" (there, I took those rose-colored glasses off for you).
One of our noctors is routinely 20-30 minutes late because of "muh traffic" while the department is melting down. Somehow this is just accepted, and the powers that be don't ask her to stay late to make up the difference in scheduled hours.
In the grand scheme of cosmic karma, show up to your damn job on time. Why is this so hard? You had to do it in med school, you had to do it in residency. It's not cute, it's not cool. You can get a pass once in a while. Don't make being late a habit.
Note to self: thank my colleagues for being exceptional.Yeah, you are.
If you're single coverage and a cardiac arrest rolls in at 0703 and your relief is 15 minutes late because of "traffic", you're gonna be doing some stuff and writing a chart. There's no warm handoff of that.
To each their own. I wouldn't routinely hand off an active resus, but maybe the culture of your shop is different. Unless the circumstances were really unusual (patient reasonably stabilized on the vent, has access, waiting for the helicopter, whatever).Your acting like extreme edge cases in a specific sign-out circumstance are the routine outcome and using inflammatory language to back up a practice that is all about local culture and has nothing to do with professionalism. No one is talking about routinely showing up 30 minutes late but aiming to be on time and rarely being 5 minutes late is reasonable as long as the same courtesy is extended to everyone. You've unilaterally decided to do 2 hours of unpaid time in the hospital a month and think everyone else is shackled by your decision which is not reasonable. The problem is people being on different pages or being treated differently and not with any specific approach. It's the same bull**** that pops up with people calling in sick or having personal emergencies.
Note to self: thank my colleagues for being exceptional.
In your scenario it would be perfectly acceptable to stay and manage that patient from start to finish. It would also be perfectly acceptable to say "I just tubed this guy from our lady of clinical incompetence nursing home, he's a hot mess. Here's what I know. I'll write the intubation procedure note, the rest is all you."
Again to reiterate though, I don't work with anyone who is habitually late by more than a minute or two.
I never actually entered the hospital until about 5 minutes before my shift. I'd get there about 15 minutes early, listen to a bit more of my podcast in the car, reply to a text, etc. and then walk in only when necessary, but still early enough to get settled in time to take signout right on time. That way I felt like it was still my own time, not dead time that I was just wasting. But if I did hit traffic or whatever, the buffer was there.
If I only caught the case because my relief was late, I would have no compunction giving it to them when it’s time for me to leave.I guess it was just the way I was trained, but I wouldn't sign off a patient I just tubed with a procedure note and then yeet it to the oncoming doc. The idea makes me feel weird. It's just not how things are done, it seems sloppy. At least stabilize them to the point they can go to imaging or have the ICU come down and do stuff.
I don't know maybe it's a culture thing or a training/residency thing.
Are ya'll tubing and coding people and then doing just the procedure note or dropping your .signout smart phrase? Jesus
Side question: "Have the icu come down and do stuff?" I don't think I've ever worked in a hospital, residency at a massive tertiary care centre included, where an intensivist was ever in the ED managing a patient of mine unless I'd already signed it out to them and it wasn't actually my patient anymore. How does that work on your end?I guess it was just the way I was trained, but I wouldn't sign off a patient I just tubed with a procedure note and then yeet it to the oncoming doc. The idea makes me feel weird. It's just not how things are done, it seems sloppy. At least stabilize them to the point they can go to imaging or have the ICU come down and do stuff.
I don't know maybe it's a culture thing or a training/residency thing.
Are ya'll tubing and coding people and then doing just the procedure note or dropping your .signout smart phrase? Jesus
I don’t care at all if my relief is 10-15 minutes late. We have 2h overlap , I see pretty much everything up to their start time, document, finish what I can finish and go home when it’s time. We also get paid for overtime if needed. But i wouldn’t be staying over to finish a x:06 code .. that’s more the “saw 3.5/h and still have stuff to do and it will take longer to sign it out than to just do it” situation.What I don't get is the cognitive dissonance. I'm assuming it's universal to be annoyed when your relief comes in late. How do the people who are chronically late get irritated at others but rationalize their own behavior?
Side question: "Have the icu come down and do stuff?" I don't think I've ever worked in a hospital, residency at a massive tertiary care centre included, where an intensivist was ever in the ED managing a patient of mine unless I'd already signed it out to them and it wasn't actually my patient anymore. How does that work on your end?
As to the sign out thing, this is again a rather extreme edge case that you've pointed out. I can think of one time in the past 6 years where it's been relevant, but yeah, in that scenario a code came in. I started running it. Guy had already been tubed by EMS. Relief came in maybe 3 min into it. We talked about what was going on for 5 more minutes or so as we co-ran the code and he gradually took over and I went home.
I would expect to do the same for any of my post-overnight colleagues in that scenario if I came in as the morning doc.
Yep. There’s a doc in my group who comes in, SEES ME sitting there with my bags at the end of my shift waiting to sign out, and GOES TO THE LOUNGE FOR 25 minutes. Who goes to the lounge for 20 plus minutes at the beginning of their shift anyway?We had a couple of these losers at my previous shop. Literally arriving 20 min late to relieve night shift single coverage guy, putting stuff down, saying "I'm gonna grab breakfast and then take your sign out."
There's a term for this: narcissistic personality disorder.
Yep. There’s a doc in my group who comes in, SEES ME sitting there with my bags at the end of my shift waiting to sign out, and GOES TO THE LOUNGE FOR 25 minutes. Who goes to the lounge for 20 plus minutes at the beginning of their shift anyway?