Friday, July 9, 2010

Incompetent or Evil?

Often times in residency I have had the experience of being the recipient of a patient from another care team.  Outside or inside hospital transfer, Emergency Room sign out, ICU admission for worsening status.  A common sentiment amongst my colleagues on the medical and nursing side, is that patients are never quite as billed, usually sicker/more complex.  Now, I acknowledge the inherent bias in being on the receiving end--simple/non-ill patients are rarely transferred.  We only see the tough cases, and that is one of the benefits of being a tertiary referral center. 

But that is not my focus here.  When a transferring team sends us information ahead of a patient that does not match the patient's history (allowing for reasonable status changes in transit), the failure lies along an axis that runs between incompetent and evil.  On the one hand, maybe they are overworked, poor systemic support, just came on shift, have a different perspective or information, have not had a chance to look at the whole picture, etc.  On the other hand, maybe they just want a difficult (medically or socially) patient transferred quickly, no questions asked and will say or do whatever is necessary within reason to accomplish the transfer. 

Incompetent or Evil, that is the axis.  I would also argue that lazy is on that axis, right about at the center of it.  A little incompetent, a little evil, but the wrong information story told no matter the reason.

Glad to be done with night float...

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