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Wednesday, January 9th 2013

Do Nothing

I’ve been reminded recently how much of medicine is watch and wait. I’ve been reminded of it in the context of being on call and cross cover. When I’m not on service but I’m taking overnight call I think I probably do less fiddling and tampering with patient’s care than when I’m on service and seeing the same patients day in and day out. Getting along in training also probably predisposes me to such inactivity.

And I’m not sure that’s a bad thing.

As every resident, I get a lot of phone calls from nurses when I’m on call in house. A lot of it is tedious and just things to be taken care of from afar, such as the day team didn’t reorder restraints, and a lot of it is just unnecessary, such as the patient doesn’t have an incentive spirometer at the bedside at 2am, and a little bit of it deserves undivided attention and action, such as the patient has had a legitimate neurological status change, but some of it is just stuff that just raises a shrug. Examples from my last call include the fact that a patient’s urine output was only 20cc for an hour but their pressures were fine, that a lumbar lumbar drain hadn’t drained anything for the last hour but was tidaling, that a patient threw up once but already had prn antiemetics available, that a patient with a monitored head injury and concurrent ARDS and maxed ventilator settings on his current mode had a stable but less than ideal pCO2 of 44.

Thanks for the update, I guess, let’s just watch and see what happens over the next hour or two or three.

Behold the issues turn out not to be issues at all. The patient puts out plenty of urine over the next hour, the lumbar drain starts draining over the next two hours, the patient doesn’t vomit again, the patient’s pCO2 stays stable and he has no intracranial hypertension issues.

Maybe it is just a matter of better triage, teaching patience to those at the bedside. Then again, even if the phone call was after the still tidaling lumbar drain hadn’t drained anything in three hours my solution might still be to just stare at it. It seems to work. I guess helping the triage process and separating the wheat from the chaff and knowing when to just shrug and watch is just part of being a resident; maybe a physician in general.