You can save yourself and your patients a lot of time if you work on mastering the ability to “get the ball rolling”. Basically, it means anticipating what the next steps are, and facilitating them. Let me give you an example…
Let’s say you are calling a consult. You are post-call and overnight your patient began to experience a change in mental status. Now, you want to call a neuro consult.
Guess what? You will notice that there’s a pattern. When most neurologists come by, they order the same type of stuff when it comes to a change in mental status. They’ll say let’s check a TSH, a B12, a folate, an RPR and a sed rate. Maybe if there’s no recent head CT they’ll suggest that or an MRI. This isn’t a knock on neurologists… it just is what it is.
Anyway, you can get some of that ball rolling by ordering some of those same tests that you know they’re going to order. And this does a couple of things for you…
- It saves you some of the time in having to track down the neuro recommendations later on in your post-call day. (It also saves you from signing out more stuff to your cross-cover resident or intern)
- It shows the neurologist that you’re thinking about things and not just calling a consult out of reflex or out of playing defensive medicine. (These guys have a role in your residency evaluations)
- It saves the patient from having multiple blood draws in the same day. (Which, by the way, will do wonders for your rapport with the patient – if you take 30 seconds to explain the plan for today and that you will be limiting their blood draws and giving consultants someting to work with.)
- You can potentially shorten the length of stay by half a day or even more.
- You can potentially identify something of huge clinical importance before the consultant even gets there… helping your patient with more rapid, more appropriate treatment, and making the consult more interesting to those on the neuro team.
- Also, it sort of forces the consultant into action. They have the data they were going to request, so now, they have to act on it.
Don’t order unnecessary tests, but you get my point. If you know that something is going to happen, start it happening. Why does it have to wait for them? It doesn’t. Be proactive.