Premature Closure

During this first day of the Telluride Experience, the main theme was communication. One specific aspect that I want to focus on is premature closure. I have seen so many residents have conversations with nurses on the phone and make assumptions and cut off nurses–sometimes due to their own egos, feeling burnt out, or busy and not knowing how to prioritize. But I know that there are many instances that nurses were truly instrumental in saving patient’s lives, and if I would have ignored their concerns, I’m not sure where those patients would be today. One recent instance that stands out in my mind is when I was called by a nurse about a patient was POD1 from an abdominal hysterectomy (who had been rounded on that morning and was doing well). She told me the patient’s hands were very pale and her blood pressures were low (100s/60-70s), even though we had not restarted her anti-HTN medication. I came to see the patient and her hands were noticeably pale with no capillary refill, and she complained of worsening abdominal pain. When I examined her, she was guarding and her abdomen became rigid. I immediately called the attending, who did come to see the patient as well, but decided on a CT scan because the patient was not tachycardic, still making good urine output, and overall stable. The CT scan did delay her care, but eventually later that day we went to the OR and removed over 500cc of blood clot and hemoperitoneum. We found the bleeding pedicle from the surgery and reinforced this area. The patient did very well afterwards, but I wonder if I had brushed the nurse off and prematurely closed that conversation, how long would it have been before the nurse called again or went over my head? What if she never spoke up again until the patient was in a worse situation?

In the end, the challenge I face is that although I heard this nurse and came to see the patient, how many of my colleagues don’t listen? I know that these communication skills come from training and from role modeling. I am grateful that I see many attending physicians who excel at communication skills, but I continue to work on teaching my junior residents these skills. I hope that by continuing to work on my  own communication skills and work with interdisciplinary teams, this will help me teach others and model these safer behaviors.

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