More stupid referrals...
I virtually use the word stupid as some of my colleagues in other hospitals just don't know how to make referrals...you can't just simply pack someone and send it to somewhere else and hope that they can do something magical that wound save the patient.
On another one of my on-call nights, I had an urgent page at 1am in the morning. When I returned the call, I heard a vietnamese doctor (who could barely speak good english) on the line (bear in mind, he was working in a government hospital). He had an elderly lady who presented with UGIB scope has been done 2 times already and transfused 12 units of blood. I asked him nicely why are referring to me for at this hour when the patient is probably still bleeding. He said " For further management". I gave him back, "What further management you want me to do? You have a surgeon there who can do scopes but he can't do a laparotomy to secure the bleeding? " It was like he didn't even know what he was doing. I had consulted my surgeon and he was pretty pissed about it too. When I had finally resorted to ask him to discuss with his surgeon again, then he only told me about the reason for referral. They had wanted to ask if there was any other possible intervention by scope method to stop the bleeding before surgery. I was very frank with him, it 1 something in the morning for goodness sake, and your patient is barely stable for a transfer (the patient is currently admited in Temerloh, Pahang), inview that she had very high risk of bleeding/rebleeding which can happen anytime while in the ambulance. In the end, the MO never paged me back...not sure what happend to the patient, but I know she definately needed a laparotomy.
Lesson to learn - when you refer a case, besides stating the history, please have your purpose of referral, and not just say 'for further management; cause that really pisses me off. At the same time, please choose the nearest hospital, not always a preference hospital (as it might be too ill or dangerous for the patient to travel 3-4 hours with no proper/full medical equipment). Making a good referral will not only do good for the patient, but it will keep us expected of what is coming in...etc, we might need ICU support, ultrasound, CT scans and we can get them ready prehand before the arrival of the patient.
There are more scenarios which I would like to share...but I'll save them for later.
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