The Pensieve

In my previous posting, I used to get called about hypocounts (ie. blood glucose levels) of <4 or >20. Perhaps the occasional 18 or so.

However, in my current workplaces, my calls are punctuated by fruitless conversations such as these:

Caller: Hi, my 20/6 has a high hypocount.
Me: Oh, you mean HI? (that would be >33.3)
Caller: 13!
Me: one-three or three-zero?
Caller: ONE-THREE
Me: Er, that’s ok. Don’t need insulin.
Caller: Sure or not? So high.
Me: No, don’t need.
Caller: Ok.
This exchange might take twenty seconds perhaps, nothing much but a blink of the eye in our daily life, but put 5 of these calls and the irritation together and it just stops me from doing the more important changes on call.

What I’d like to know is who taught the caller that 13 was a HIGH hypocount?
And I’d like to know what sort of training the callers in this workplace has been undergoing that taught them to bother the on-call with such inane questions.
One thing about some of the staff in this place is, they sadly do not exercise the significant amount of grey/white matter that I’m sure they possess.

On a call, I arrived at a nursing counter about 2 hours after they called me, since my pending tasks were: ink up drip for NBM pt and seeing a patient complaining of chesty cough. I saw to my horror a list of tasks written out for me at the counter, the last of which wrote: 10/2: BP 92/60.

It blinked red at me, so I questioned the staff nurse about why this wasn’t communicated to me by phone.

Her reply: Patient is so comfortable and sleeping.

I was really alarmed at her reply, I felt that even if it were so, should at least flag it up, so I advised her to flag it up the next time.

Her reply: You don’t tell me what to do, anyway your HO friend (apparently it was the active HO) went to see patient and said ‘just observe’.

Anyway I was quite pissed at her lofty views of her assessment. I went to see the patient, true enough manual BP was 80/50, not tachycardic though and quite comfortable, but still, it worried me that there was a drop from baseline of 110/90.

I casually asked the patient if indeed another doctor had came to see her previously, but she was rather certain she had been sleeping really well till I came along.

It was very disturbing to me to hear of another colleague apparently assessing only a patient’s vital charts instead of personally attending to the patient. It was equally disturbing that the nurse acted so complacently. Furthermore, when I lightly advised her to flag up BPs like this in future, she had retorted by saying that ‘next time I’ll call you for any small thing’.

That active HO who apparently had ‘assessed’ the patient (no doubt s/he had xray vision) or an uncanny ability to assess a patient by NOT looking at the person had not even bothered to do any documentation of sorts.

It’s this kind of (I don’t know how to describe this kind of attitude) that causes us to miss out real red flags.

Sigh.