Context: Patient has been rounded on by a physician 4x this day at this point that I knew about. (Twice by myself, once by the intern alone, and once by the attending alone.) Has been inpatient for 3 days, and I have personally examined each extremity twice daily for peripheral pulse checks. I just got home for the remainder of that day’s “home” call. Remote-logging into the antiquated system is a 30minute ordeal and this hospital doesn’t take verbal orders.
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Nurse: “Patient is complaining of a rash on his leg. Can he get some hydrocortisone?”
Me: “What rash? When did it start?”
Nurse: “Oh, he says it’s been there for weeks. He says it’s really itchy and has been bothering him badly for days.”
Me: “Weird, he’s never mentioned this before. Had you tried reaching the (in-house) intern first?”
Nurse: “Yes, multiple pages, no response.”
Me: “I’ll see what I can do…”
I contact the intern - yes, she had gotten the page, had seen the patient yet again, he denied having a rash or itching, but she had ordered some topical cream to placate the nurse, and had talked to the nurse in person.
Call the nurse back- “So, Dr Intern says she saw the patient and talked to you. What happened?”
Nurse:”Ohhhh, she’s a doctor? I thought that was just a medical student or something. Yeah, yeah, she ordered some cream. Thanks!”
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The kicker was that when I saw the patient the next morning, he denied having an itchy rash, there still wasn’t one on exam, and he said it was something the nurse “noticed” and that he was fine. The cream was never used.