Sign-out really needs to happen more than once a day

Our attending’s goal is to make rounds fly by as quickly as possible, with a bare minimum of any actual HPI or physical exam findings.

Our Sub-I’s goal is manage their patients by themselves, as an actual practice for residency.

Our senior resident’s goal is to discharge / transfer people out as quickly as possible, because she has one foot out the door.

And the night intern just wants to get a sign-out from us that doesn’t suck and addresses all their questions so they can take care of like a million kids.

I get up early every morning to review the list of kids on the ward (all of them, not just the ones I’m assigned) because I hate getting called to the bedside of a kid I don’t know. (Rounds are supposed to mitigate this kind of thing, but we go so fast – and our turnover is so high with all the discharges, that it usually doesn’t help.)

“Yep, I’m the intern. Nope, nobody told me that this patient even existed. No, I can’t believe it either. The lack of communication here is stupid, dangerous, and totally unnecessary.” <– is what I don’t say. But it’s true.

The sign-out list I’ve been carting around is now no longer relevant and so I page the senior. Maybe she gave the patient to one of the Sub-Is? Maybe she’s been managing that patient herself because she wanted me to finish discharging my other kids? Maybe a ghost put in the admit orders?

So I show up to the nurse’s call, make sure the kid isn’t actually coding, make a couple minor interventions to bide some time (Let’s stop the feeds and try some blow-by even though I don’t know the patient’s history!) and page the senior.

Today the medical students looks at me sadly like, “You couldn’t even handle that yourself?”

Nope.

You could actually see the respect draining out of their eyes.