I consulted neurology for a patient this past week. I have to admit I’m still pretty nervous talking to a specialist, acting like I know what I’m talking about. Switchboard told me I’d have to go through their answering service, where you leave a message with basic info about the patient, how you can be reached, and your title. I, the lowly student intern, said as much. Still, I thought that was weird since I’d paged neurology before directly, no answering machine.
I don’t know much about consults, but I can tell you when I got the phone back, the fact that I’d said I was a student rather than a resident or anything else definitely factored into the dynamic of this phone call. Instead of being asked a few quick questions about the patient’s status, recent history, things we’ve tried, etc, I had each of those questions followed up by some typical grilling questions that every student is used to by now–nay, pimping. “So what do you know could cause a seizure for someone who was previously controlled?” “Um, well, I looked for anything in her labs–” “What exactly are you looking for in her labs?” “Well, I guess… her sodium has always been normal–” “Yes and why sodium?” “Hyponatremia can cause seizures…” “Okay good. What else do you think is contributing to her seizures? What causes seizures in anyone?”
Like really dude, are you asking me to answer questions that even staff neurologists don’t know? Does anyone really know what causes seizures? Does anyone know anything about brain and its intricacies–aren’t we all going off pretty much guess work and empiric therapies that have been tried and true? Is this really helpful to the consult?
I just know that if I simply hadn’t stated I was a student, I probably wouldn’t have gotten grilled like that and we could have had a much more efficient phone conversation. I was surprised that this person I had never met or seen or talked to felt that he should take this opportunity to give me teaching, not concerned that it might have been a busy day, not knowing that my team had left to continue rounds, not really caring either way, I’d bet. It came off a smidge arrogant for him to assume that role despite knowing nothing about my situation, but then, maybe that’s how the hospital works. Maybe occasionally consultants get bored and do take the time to teach on the phone, or maybe he’s truly keen on getting all students to have a thorough understanding of epilepsy. I have to say he gave me some useful information, and I wasn’t offended–I’m very aware of the rank SIs have on the medical food chain. Just surprised, I guess.
The best part was, at the end of the conversation: “Well you sound like you’re doing a good job with this patient–now just one thing, did you mean to page neurology? Because I’m neurosurgery. Yeah, it’s neurology you want. Switchboard made a mistake.”