A special occasion

Today, the interns all rotated to new services, and we got a new intern – Dennis. He was a nice young doctor with a can-do attitude and a very friendly disposition. I took a liking to him immediately. Another new event – an internist from Manitoba came to round with us and attend on our service. Since we had an attending with us, Dr. Wilson was eager to put our best foot forward. So when we had patients with Cryptococcal meningitis vs. TB meningitis, and Dennis had failed to procure the lab results, including our CSF analysis, Dr. Wilson dispatched me to go get them. Since I was down on the third floor anyway, I went and got all the lab results from the different departments – Microbiology, Clinical Chemistry, Immunology. I even went to Haematology to pick up the packs of whole blood we had ordered to transfuse our severely anaemic patients, including one with a Hgb of 2.0. Oh, the wonders of the body’s ability to adapt, even to such low levels of Hgb that should be incompatible with life!

Rounds are so much less efficient when you have someone new who isn’t familiar with the patients. We had to present every patient in a fair bit of detail, and have our clinical decisions questioned. The attending was very cost-conscious, and reprimanded the team for ordering new tests instead of trying to track down records from outside hospitals. He also questioned our decision to prescribe a very expensive drug instead of a cheaper alternative for one of our patients with neuropathic pain. Slowly, throughout our rounds, I came to understand one thing. Dr. Wilson believes in providing the best care to his patients. He never settles for anything less – no cheap alternative for his patients; they only get the best available service, medication, everything that our team can offer up. It’s one thing if the hospital is out of a certain drug or a service is unavailable (which happens more often than not) but if that is not the case, then why should his patients get anything less than the best treatments available? Our attending was approaching the issue in a system-based way – save money for the system, and more services to go around for everyone. Dr. Wilson was approaching the issue in a patient-based manner – give each and every patient the best possible care. I certainly can’t argue with either point of view.