The Hidden Lives of Doctors, Part I: The Art of Signing Out
The author wishes to announce the first of an occasional series dedicated to revealing the secret culture of the intrepid men and women who have chosen medicine as their life’s calling, not to mention a way to pay for the kids’ orthodontia. We kick off this series with a heretofore undescribed look at one of the most sacred of all medical rituals, a ceremony practiced by doctors young and old, from every corner of the country, in every speciality where the well-being of the entire patient is of interest (which rules out dermatology, psychiatry and of course that branch of medicine where a live patient is not necessary for one to whistle while one works). We refer to what is colloquially known as passing the baton, or blowing out of here, also known as signing out. It is during this act that the crucial details of a patient’s case are outlined to the doctor assuming care for the next tour of duty. At first glance this would appear to be one of the most lethargic discussions ever chronicled, capable of dropping anyone who dares to listen in faster than a well-placed dart from a tranquilizer gun.
That, dear reader, is where we are wrong, for a signout session is full of high drama and intrigue. It’s just that the casual listener is unable to decipher the abstruse jargon and sarcastic innuendo that goes on during the verbal jousting between the departing doctor and his traditionally unhappy replacement. Picture this scene taking place in some pizza-box laden corner of a nurses’ lounge. On our left we see a giddy sleep-deprived resident who can hardly wait to read the last name written on his grimy piece of paper so he can then jump into a battered 1988 Camry and make a beeline for the upper bunk. Over on our right we find a beleaguered soul staring blankly into space as he writes. This person, obviously the on-call doctor, is easy to identify by his unwrinkled shirt and his poorly disguised look of agony, often seen in paratroopers who forget to attach their chute to the static line. What controversy could possibly exist in such a mundane activity?
After twenty years of being victimized by these charlatans I can answer this question easily, namely that doctors tend to view the signing out procedure like a lioness stalking a wounded kudu, and one can very well guess which is the predator and which is the entree in this little tete-a-tete. Let us therefore parse the signing out procedure for what it really is: a sales transaction where the seller (going off-duty) is eagerly trying to gain the upper hand by using every trick in the book on the buyer (coming on-duty). For any young doctors out there reading this, I provide this compilation of schemes to be aware of:
1. The Early Sign Out. On the day of the transfer would it be asking too much if you would at least wait until the sun has crested the skyline before hovering over the on-call physician with your sign-out list? During my residency we used to vamoose so early our patients started reading their own x-rays just to keep up to date. Upon hearing of our little chicanery the Chief quickly put an end to it in his typically graceful way.
2. The “Cast of Thousands.” C’mon now, do I have to see every single blue-haired granny admitted for some R & R from her loony husband? How long is this list anyway? Aren’t there some patients who can be followed by “telephone rounds,” which means if they don’t telephone you, you don’t know they exist?
3. Late Arrivals. There is nothing more depressing than to get a call from your colleague that starts as follows: “I just spoke with the E.R. at Pigeon Forge and they’re transferring this guy to you - he should arrive in about five hours.” Egad - there goes my plans for dinner and a movie.
4. Scut Work? No, Not That! Beware of the peer who casually asks you to check on the results of biopsies, cultures or other results that could bog down your entire weekend. Please, please tie up all loose ends of patient care before jetting off to Crapsville, leaving us poor on-call slobs up to our tongue depressors in work.
5. The Psych Alert. As a courtesy to the covering physician we (discreetly) ask that you notify us of any and all patients and family members who are off their rocker, or uttering voodoo curses, or seething with anger, or simply in a coma. Think of all those World War II movies where buddies look out for each other when on patrol. Do we deserve any less?
6. The Maiden Voyage of the Titanic. This is otherwise known as the impending disaster, where a patient isn’t doing so well, but gosh, it’s time to go home, so the departing physician reassures his covering partner with the gentlest breezes of euphemisms that this patient is tucked in for the night. One can imagine what happens in Act II as the on-call physician, just minutes ago burrowed under the sheets and drooling on his pillow, is now racing down the hallway toward that same Mrs. Jones, billed as “a mild case of bronchitis” at quitting time but now sitting bolt upright in bed, her eyes coming out of her head like the Bride of Frankenstein as she gasps for oxygen.
I could go on, just as I’m sure others can add to this list, but for now that is enough. When it comes to accepting the sign-out list from a colleague, my advice is the same as with any transaction where the phrase “slimy weasel” may surface in the aftermath: Caveat Emptor!
