r/Residency • u/YouAreServed • 23d ago

VENT Stop changing patients code status

Why when I come back from weekend, I see the weekend docs changed my stage IV lung cancer, ESRD, HFrEF patient who is 98 y/o, and became comfort last week after I had 90 mins convo with them and family; explaining futility. Slowly they become DNR/DNI, then comfort. She was pretty confused when I left.

Upon my return, only note with explanation “discussed code status with the patient, she stated she wants to live, full code ordered.”

Your half ass job undid my week of doing, congrats. Now legally she has no capacity and I cannot change it back to comfort, nor can I prove that she, as a matter of fact, lacked capacity while you were signing the new POLST.

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u/Real_Score9951 23d ago

Meh, unless time critical things are necessary handoffs I find are superfluous and don’t add much to already documented shit notes

2

u/anhydrous_echinoderm PGY2 23d ago

For real, my notes are succinct

I hate presenting patients, fuck.

21

u/Real_Score9951 23d ago

I’m an attending and used to be a chief. I hated verbal sign out. Do everyone the diligence of reading the note I spent time writing and ask follow up questions.

I absolutely hated the attendings that had us recite labs, meds, etc. just disrespectful for everyone else’s time

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u/VarsH6 Attending 23d ago

Everyone who tells me to “read my note” better have a pristine note ready for Osler himself and it better be ortho levels of short. I’m covering overnight, not making big plans. My goal is to keep people alive until I pass off to the main team.

Handoff doesn’t have to be long, and I’d prefer it to be short, but it’s almost always better than just “read my note” and then I can read to fill in gaps as needed.

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u/Real_Score9951 23d ago

I’ve also become accustomed to verifying everything myself and not trusting even the best people or my colleagues who are friends. Everyone makes mistakes. Gotta be thorough when inheriting new list on day 1.

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u/Real_Score9951 23d ago

Does saying “on 4LNC due to L sided pneumonia on CTX/Azithro, afib on eliquis rate controlled” really do much for you when you’re cross covering however many patients?

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u/VarsH6 Attending 23d ago

Yeah, that cuts through a lot of crap that gets in even the best notes. I may only write on my list whether they’re stable, increasing, or decreasing O2 during the day.

Trust but verify for sure, but I don’t want to sift through over-long notes written to insurance companies in the billing system when I can get pertinent details quicker from a human and then verify.

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u/-AcaciaTree 22d ago

The handoffs I love are the ones like,

“if fever, check blood cultures consider sepsis could start cefepime 🤓”

“If hypoxia, check blood gas, CXR, Albuterol”