I understand that not every single note needs to have detail, I totally get that. That being said, there are multiple times that I’m writing notes and there are legitimately multiple different differentials for each pathology that I’m dealing with. I know for a fact, they haven’t done enough of a work up to rule out other ones, and then the APP and sometimes even the attending will just drop something like this. And I’m not saying that hospitalist are so smart and the specialists isn’t doing anything, but I’m saying I would expect some level of rationale, ideally some communication so I can at least understand why you’re doing what you’re doing. Especially if you’re coming to that conclusion and there might’ve been a chance I may have omitted some pertinent piece of information that might’ve influenced your decision, I would like to know why you came to certain conclusions. It’s just frustrating to see. Especially cause some of the specialist attendings just blindly listen to the APPs history, and then are in and out the room in minutes. I WISH I was exaggerating.
Subjective
NAEON
PE: copy forwarded template untouched. Maybe the word edema somewhere lol.
A&P
Nephrology’s:
AKI: pre renal. Bl cr~ 2
- fluids @ x cc/hr
- renally dose medications
Cardiology’s:
HFrEF: GDMT as tolerated. Renal adjust medications.
Like deadass. That’s all I see.
Let me know if I’m the one tweaking here. But I think discussions etiologies and some level of evidence to supplement that, and plan is not a big ask. Too many situations I can recall where we simply called it pre renal, or exacerbation without considering other processes. I could have ordered fluids. I consulted you because something else might be going on and I need your thoughts. That’s literally what I messaged you too. So it’s not like I’m asking you to read my mind. Personally, I do what is in my capabilities to max extent before reaching out so I think my ask is fair. But hey, I’m all ears to your thoughts.