GAAAAA!

As the intern, there are so many things I know that I don't know. Some things, however, just don't feel right. I'm used to double- or even triple-checking my work just to make sure nothing's slipped through the cracks, but sometimes things slip through. Sometimes, however, it's not me who's missing something.

 After seeing a patient for a relatively simple consult. I called the primary team to give our recommendations. "okay", was the reply, "what about transfer to medicine?"

"Excuse me?," I said, "you didn't mention that when you called for the consult."

"Maybe I didn't communicate that clearly, but there's also a question about transfer to medicine" the surgical resident replied.

"Okay, but the patient has no active medical conditions," I said

"We're not going to do surgery, so we can't keep her and she can't stay in the observation unit past 24 hours"

"I know that, but she doesn't meet admission criteria for medicine"

"She has MULTIPLE medical problems!!!!!"

"That's true, but none of them are active. medicine can't accept the transfer."

At this point, sensing I wasn't getting anywhere, I told the resident I would talk to my senior and get back to them.

My senior resident agreed with my assessment but suggested I run it by the attending just to prevent too much pushback from the surgical team.

I went by the patient's room to check on his condition and to make sure I hadn't missed anything. I ran into the surgical resident and went another round as he insisted the patient needed admission to medicine and I explained that we couldn't do that, the patient did not meet criteria for admission, and that I had included recommendations for home medications and care in my note.

The resident clearly wasn't happy, but I did what I could and gave my senior resident the heads up. It was a good thing too, as she then got an extraordinarily angry call from the surgery chief resident about it.

This was one of two cases that day where surgery requested an inappropriate transfer that we turned down. My senior resident and my attending had my back, and it was a really good feeling when they told me I was correct and had done the right thing. I know I'll miss things and make plenty of mistakes, but it's nice to know I can do things right sometimes too.