Can you just leave?

You are moonlighting in some rural ED. You have woken up as you did get some sleep. It is 8:30 am and the new MD should have just arrived. You make yourself a coffee, have a quick shower and head to the department. The day nurses have arrived and are chatting. They do look fresh and clean and the smell of coffee from their coffee cups makes you feel great. You crave the bagel that one of them has brought in but remember your diet. There is a patient registering but its not for the ED. They have to register at the ER desk for X-ray, US etc. You breathe a sigh of relief. You just want to go home. The nurses say there is nothing for you and Dr H who is supposed to be your relief is going to his office first to catch up on paperwork as he has a busy clinic in town. He may even have a patient to see who was not doing well overnight and has been booked in the clinic. He has asked to be called in if there is anything to see, but he didn’t give any handover instructions. He has asked not to be disturbed for anything else as he will be busy with the office. You suddenly remember the 80 year old you saw at 3 am who had some dyspnea and quiet crackles. Her oxygen sat was 79% with normal ECG and a mild degree of pedal edema. After some ventolin, oxygen, lasix and a dose of ceftriaxone, she is quietly sleeping, waiting for the myriad of tests you ordered for 9 am. You can’t believe you forgot to wake up and check on her at 6am, like you had hoped to do. Darn the night nurse for not waking you up. You have a quick look at her and decide its time to let Dr H know that he has one patient to assume care of. She has been stabilized and is looking good. The nurse calls Dr H for you and after speaking to him for all of 3 seconds she sheepishly hangs up and says “He said he will be an hour and doesn’t want to be disturbed. The patient he brought in to clinic is in a  crisis“…. You look exasperated and the nurses say “Just leave. We can tell him about the lady. If he wants he can call you to discuss it further. We do not expect you to wait. Plus, in our rural EDs we do not have a physician in the ED at all times“. You are happy with this plan. You do remember being told that rural EDs do not need a Doc in house 24 hours. You call your boyfriend, a surgical resident, and explain this to him. He listens patiently but then asks the quintessential question : “Can you just leave like that?” The doubts start to run through your head. What do you do now?

4 thoughts on “Can you just leave?

  1. I don’t think it would be appropriate to leave given the uncertainty in the situation. For example, what exactly is this crisis that is going on? If an emergency came into the door or if our patient that we admitted clinically deteriorates, would Dr. H be able to leave his clinic and come to the ER promptly?

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  2. I would call Dr. H and verbally give handover (I would not take no for an answer from his secretary) and then I would contact the chief of staff of the ED to inform myself of what the hospital policy is about “handover” and having a physician “in-house”. If I had a patient(s) that was at all unstable I would physically stay in the department until Dr. H arrived. I would also see if there was any other physicians in house, in case there was an unstable patient that happened to walk-in and Dr. H was still not there.

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