“I asked the nurse for a psychology consult for Gloria Teller on the third floor,” the dietician told me. “She’s not eating well, and when I went to talk to her, all she could do was cry.”
“Thanks,” I replied. “I’ll keep an eye out for it.” I jotted the name down in my book so I could follow up. Consults had a way of going missing.
Sure enough, after a week had passed and no consult appeared in my mailbox, I began to track it down. Putting on my Sherlock Holmes cap and taking out my pipe, I considered the possibilities: the nurse could have forgotten to write the consult, the order could have been written but no corresponding consultation form was generated, or the consult form could have been misplaced on the way to the mailboxes.
I wonder how many other consults go missing?
I wonder if a clinic appointment gets cancelled, how often it’s rescheduled?
I wonder if a family member tells the aide that her father does better on Medication B than on Medication A, if that information ever gets to the attending physician?
I wonder if I leave a note for the doctor on the floor where he has only one resident, will he see it in a timely fashion or at all?
I wonder if we’ve run out of MD order forms, how many orders go unwritten?
I wonder who’s in charge of the FLOW of communication, because it seems to me that while we’ve got department heads, we don’t have an INTERDepartment head, and we could use one.
Back to my consult: I started with the most likely scenario and asked the nurse, who replied, “Oh my gosh, I completely forgot!” She pulled out some papers, scribbled furiously while telling me about the emergencies she’d been fielding the day the dietician spoke to her, and thrust the yellow consult form into my hand. “Ms. Teller really needs you. She’s a mess.”