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DrHedrick's profile
Dr. Hedrick
Dr. Hedrick
Dr. Hedrick
@DrHedrick

Tweets

Dr. Hedrick

@DrHedrick

Heme/Onc. Tweets are my own, not medical advice, not affiliated with my employer, and often whimsical.

Indianapolis, IN
Joined September 2010

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    Dr. Hedrick‏ @DrHedrick 18 Aug 2018

    Dr. Hedrick Retweeted C. Michael Gibson MD

    I have a lot of thoughts here. Full disclosure: I'm a cancer doc, so I could be making this phone call. I trained from medical school though fellowship at the same institution. I have, by my choice in training, cared for someone I knew personally. In no particular order...https://twitter.com/CMichaelGibson/status/1030467533416087553 …

    Dr. Hedrick added,

    C. Michael Gibson MD @CMichaelGibson
    Residents refuse to admit a patient since they were "capped" (took as many admissions as #ACGME would allow) Admission delayed until AM Former medical school classmate dies with pancreatic cancer Must read for today https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/74599 … pic.twitter.com/KX1z5nD6Ls
    6:05 PM - 18 Aug 2018
    • 39 Retweets
    • 134 Likes
    • 💧 Blue-tongued lizard Kevin Friede, MD Adam Markovitz Miguel Galán de Juana 🏳️‍🌈 calliecoombs teens get cancer too enigma4ever 😷🌹😷 #WearAMask #LongCovid KathleenMazza RN MBA PhD 𝖉𝖆𝖛𝖊 𝖋𝖚𝖑𝖑𝖊𝖗
    8 replies 39 retweets 134 likes
      1. New conversation
      2. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        1) The residents here did the right thing. They should take no shaming or blame. They did the correct and professional thing.

        1 reply 0 retweets 48 likes
        Show this thread
      3. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        Hospitals and doctors have a duty to care for patients. Residents have an additional important duty, that is to learn. That is what the ACGME and "caps" are there for. To protect the education duty.

        1 reply 2 retweets 32 likes
        Show this thread
      4. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        2) Residents should not be accepting patients this way. Maybe other institutions are different but attendings (or Chief Residents acting as attendings) should only be accepting patients coming from outpatient clinic.

        1 reply 0 retweets 28 likes
        Show this thread
      5. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        Even now as an attending I am leery about direct admits who have not been seen my me or a colleague in my own clinic. They often show up not as sold. A patient dying within hours of being called to admit, should not have been a direct admit. They should have been sent to an ER.

        6 replies 2 retweets 52 likes
        Show this thread
      6. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        3) No one should be forced to care for someone they know personally. Its hard to get a full picture but it sounds like the writer, the patient, and the residents are all in the same academic institution. Residents should not be made to care for a colleague.

        1 reply 0 retweets 37 likes
        Show this thread
      7. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        I did this as a fellow. It was someone I knew before medicine. It was a choice, I was offered to have someone else see the patient. I learned a lot from the experience, but mostly that I wouldn't do it again.

        1 reply 0 retweets 30 likes
        Show this thread
      8. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        It's impossible to not intermingle your personal history with the patient from your duty to care. It clouds the experience for you, and by implication the patient. I know attending docs who will do this, but it should not be a part of #meded

        1 reply 1 retweet 27 likes
        Show this thread
      9. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        4) The hospital and supervising attending are clearly at fault here. Teaching teams cap, but hospitals don't. It's almost absurd to think of them as the same. Was the hospital not accepting patients? That's a different story entirely.

        2 replies 1 retweet 61 likes
        Show this thread
      10. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        This scenario right here is why ultimately ERs are so necessary and shouldn't get grief about waiting-for-admit times or for "non-emergency" care. Care is what is inportant. EM docs are palliation experts. They are comfort experts.

        1 reply 4 retweets 54 likes
        Show this thread
      11. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        They can refer to hospice and palliative docs can go to EDs and start patients on the care they need. This patient should have been in an ER. They don't "love" being the person getting cancer patients end of life care, but they do it and well.

        1 reply 4 retweets 35 likes
        Show this thread
      12. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        5) A cancer patient shouldn't die this way, but importantly no one should die this way. This person was facing imminent death. If it was known from cancer (uncertain from the scenario) palliative care should have been involved.

        1 reply 3 retweets 40 likes
        Show this thread
      13. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        They can do amazing things quickly. Get a hospice bed at a SNF, arrange for transfer, get services at home... They know what they can do, and they can do it fast. But they have to be called.

        2 replies 1 retweet 23 likes
        Show this thread
      14. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        Sidebar, they should have been called WAY before this scenario.

        1 reply 0 retweets 41 likes
        Show this thread
      15. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        So in conclusion. There a lot of, as we say, learning opportunities here. But Residents are learners. They aren't in charge, they aren't experts, not everything is in their control. ACGME takes a lot of deserved hits, the admit caps really are one of their better decisions.

        1 reply 0 retweets 30 likes
        Show this thread
      16. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        If this scenario makes you angry, it should. But if you have a "back in my day" component to the anger, I would argue it's misplaced. Largely because you shouldn't have been made to do the things you did then either!

        1 reply 2 retweets 54 likes
        Show this thread
      17. Dr. Hedrick‏ @DrHedrick 18 Aug 2018

        Finally, please. If you patient needs admission and you are stymied, send them to the ED. Then call the ED to explain why. Then thank the ED for helping. Then if you are anxious, pop over to the ED to re-assure the patient. You, them, the ED team will feel better for it.

        6 replies 4 retweets 62 likes
        Show this thread
      18. Dr. Hedrick‏ @DrHedrick 19 Aug 2018

        There's one more here, that I was having trouble articulating. 6) There is a specific spin to this case, that this was an Very Important Patient and thus exceptions to rules should be made. IMHO, VIP Medicine is particularly dangerous.

        2 replies 3 retweets 46 likes
        Show this thread
      19. Dr. Hedrick‏ @DrHedrick 19 Aug 2018

        Taking care of VIPs often takes aim at established norms. "We wouldn't usually order this test but..." "I wouldn't normal call this consult bit..." "FYI, this patient is a VIP so..." all of these can lead down a bad path. That little *extra* thing done can cause harm.

        2 replies 1 retweet 25 likes
        Show this thread
      20. Dr. Hedrick‏ @DrHedrick 19 Aug 2018

        Much of medicine (and the world) relies on norms to guide us. There are clear harms to over testing. There are risks making exceptions. This is doubly true when the patient is reinforced as being more important than the person in the next bed.

        1 reply 2 retweets 23 likes
        Show this thread
      21. Dr. Hedrick‏ @DrHedrick 19 Aug 2018

        Everyone wants to be a special patient to their team. No one wants to be the person less important to the team than the person in the next room. That's a dangerous precedent to set.

        1 reply 3 retweets 32 likes
        Show this thread
      22. End of conversation

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