Sometime during your medical career I’m sure you have heard the saying, “Poor planning on your part doesn’t constitute an emergency on my part.” My experience as a radiologist says otherwise. Shift changes and Fridays at the hospital seem to positively correlate with “stat” requests in our radiology department.
According to my daughter, goldfish have a memory of about three seconds, so they are apparently in a state of constant surprise. Swim, swim, swim, WHOA! Repeated ad infinitum. Hospitals are like goldfish with slightly longer memories. Every Friday afternoon, WHOA! There’s a weekend coming! There was a time when weekends meant only limited services were available but that is no longer true. Weekends are regular workdays with less people to do the work. Say the magic word “stat” and you can have your study anytime of the day or night.
I remember discussing stat studies with an internal medicine resident many years ago. His position was that all studies had to be ordered stat because he needed the results as quickly as possible for rounds. He was not deterred by the argument that if all studies are stat then none are, because studies can only be done one at a time. His answer was “super stat.”
One current example of differing senses of urgency is venous access. In the days when central venous access was mainly the domain of surgeons, the procedures were scheduled. In our community, when radiologists began to offer image guided venous access, the “electiveness” of the procedure disappeared. Patients admitted days earlier were requiring “stat” PICC lines on weekends.
Because our interventional guys also had routine coverage duties on the weekends and the requests were beginning to come at all hours of the day and night, limits were eventually placed: Any requests for venous access on weekends received after 11 a.m. would not be done until the following day. No one would have questioned a surgeon scheduling patients in this way — but radiologists? How dare they? When this occurred one Saturday, the patient’s nurse told the family that their loved one wasn’t getting this critical, life-saving procedure because the radiologist didn’t feel like coming in to do it. Is it any wonder our image is suffering? Another nurse faced with a similar situation responded, “You mean you want me to start an IV?”
And then there is the inconvenient procedure. There seem to be some procedures that referring physicians will do during regular hours but outsource to radiology when it is inconvenient, say, the weekend or on a holiday. When cardiology began encroaching on our interventional turf, they stated that they would perform angiographic and interventional studies such as thrombolysis during the normal workday and the radiologists could perform them at night, and on weekends and holidays.
While we were required to provide continuous call coverage, not all cardiologists did all procedures and they were not required to provide the same coverage. As a result, when our group gave up its angiographic privileges as a result of low volumes, the routine availability of this service to our community was lost. This definitely seems like poor planning on somebody’s part.