While working at small rural hospital I was once again faced with the emergency physician’s dilemma.  Admitting  a patient and being told to write ‘holding orders.’  In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counter-intuitive electronic orders system.  All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble himself.  (Much less come in and see the patient old school…that would be sheer madness!)

Now look, I know I’m with the patient.  But that means I’ve already done the majority of the stuff that really matters.  The rest is housekeeping, and the domain of the patient’s personal admitting physician or hospitalist.  I don’t know when you like your repeat labs, how you like your prn medications, what you want for hypertension or really what antibiotic pathway you want to employ.  I don’t know when you want him up, or whether or not you want her to have a physical therapy consult.  I don’t know.  And ultimately, I don’t care.  In the same way as an orthopedic surgeon doesn’t really care about which oral hypoglycemic you recommend for his patient, or a psychiatrist which gallbladder imaging you prefer.

It is 2015.  We have telemedicine.  Physicians remotely, hundreds of miles away, read our CT scans and others tell us (also from vast distances) to give thrombolytic drugs.  The Internet makes medicine possible from your bed…at night…naked if you like.

It makes no sense for me to read X-rays because it’s after 5 PM and radiologists get tired.  And it makes even less sense for me to write admitting orders for patients, when 1) I’m not trained to do it and 2) you’ll do it much better than I will and 3) you will be the one caring for them, and the one who should care most about what things are ordered.  Convenience and comfort aside.

I’m not longer an intern or resident.  Write your own admitting orders.  I already did the work-up.

Edwin

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