A short confessional
I’ve learned something about myself. I hate wards.
I hate the languid pace everything moves at.
I hate the lack of resolution.
I hate the manipulation of the system, the way relatives dump patients just before a long weekend or a public holiday so that they can be free to travel, when the patient’s been ill for weeks if not months at home.
I hate the way patients assume the sick role and just lie there all day despite the fact that nothing about their particular condition warrants lying down (sir, you came in for seizures. You no longer have seizures. We’re only keeping you so we can document your drug levels. You’re not dying. You can walk yourself to the bathroom now.)
I hate the act of adult babysitting–of telling someone that they need to walk around a little bit, that they can’t just refuse to eat because the food doesn’t taste like home food (I’ve eaten the hospital food during a long break-less shift, it isn’t great but it’s far from horrible!), that they need to tell us if they’re having pain anywhere or having trouble taking a dump.
I hate phone-calls after-hours about stupid things.
“Doctor,” the nurse says in an urgent tone, “the meningitis patient is complaining of a headache!”
“OK, I’m actually not on call tonight, but let me see if you need to call the doctor who is. Does the patient still have a drip?”
“Yes, she’s gotten her Rocephin.”
“And does she still have analgesia prescribed.”
“Let me check…yes, she does.”
“So…has she received her analgesia???”
“Not yet. She has a headache.”
“Nurse, you have to give patients their pain medication regularly. Especially if they’re in pain.”
“Okay, thanks doc.”
“You’re welcome. Please only call the doctor on call if the patient’s pain doesn’t improve with analgesia.”
Based on a true story.
I hate the inefficiency in wards. There’s only one of me. I can’t see the patient, do the vitals, do the pregnostix, do the dipstix, prescribe the treatment, put up the drips, take blood samples, interpret results, authorise transfusions, take sputum samples, take stool samples, take urine samples, do lumbar punctures, do pleural tabs, do ascitic taps, discuss patients with other hospitals, call clinics, call ambulance services, administer stat doses, dress wounds…all by myself. Some things need to be delegated. I can’t delegate the lumbar puncture, but I can delegate getting a urine sample. At least I think I can, until I arrive at the wards three days in a row and it hasn’t been done.
I hate the complete lack of a chain of command.* I once had a nurse refuse to assist with a resuscitation because she had to check stock in the drug cupboard for auditing. And when I reported this I was basically told that nurses are so well unionised that we need to be grateful they listen to us at all. Which is rubbish. It’s all about the leadership in the hospital, and our hospital’s leadership is clearly fine with a complete lack of synergy and efficiency, even at the expense of patients lives, if it means never ruffling the nursing union’s feathers.
I hate taking over management of patients from certain colleagues. If I had a choice in the matter, I’d fill my ward with only new patients that I assessed on admission. At least then, if something isn’t done yet, I only have myself to blame. How do you admit a meningitis patients who has no contraindications to lumbar puncture…without a lumbar puncture. Writing “LP in ward” is simply not acceptable. Writing absolutely zero treatment in the prescription chart is even more infuriating.
If you thought there was going to be a part of this rant where I turn around and tell you what I love about wards, I’m sorry to disappoint you. There are a few things I kind of like, but I can get all of those things in outpatient department or casualty too, without all of the above downside.
I hope my patients don’t sense my utter disdain for wards and misinterpret it to be a disdain for them. Hopefully I’m doing well at faking it until I make it. Don’t get me wrong, I love what I do, but I’m going to make it my life’s mission to ensure that I don’t have to do it in the context of a ward after my mandatory community service is done.