Just because you’re smart

Doesn’t mean you get to be a dick.  Case in point happened the other night.

My friend and co-worker pages the on-call doc and when he calls, the following conversation ensues:

Nurse: Yes, I’m calling about Mr. Jones, a 55 y/o male admitted today with hypertensive urgency related to changes in medication to his intra-thecal pain pump..

On-call Doc: interupting His what? already pissed off

Nurse: Intra-thecal pain pump.  They’ve been tweaking his clonidine dosing.  His blood pressures have been running anywhere from 200s over 110’s to 180’s over 90’s.  Right now, after 200mg of Toprol XL he’s still at 188/105.  He has a history of a AAA repair less than a year ago and I’m a little uncomfortable having him run so high.  All the Toprol did was drop his heart rate.  He’s also been having episodes of chest pressure that’s been relieved…

On-call Doc:  You’re uncomfortable?  I’m OK with that pressure.

Nurse:  Even with the AAA repair and his increasing episodes of chest pressure?

On-call Doc: smugly Well it sounds like we need to modulate his angiotensin system then.  Do you know what drugs do that?

Nurse:  Isn’t that your job?  It’s why I’m calling you…

On-call Doc: breaking in again It’s enalapril.  Do you need me to spell it for you? A-N-A-L-I-P-R-I-L. nurse repeats aloud 10mg, PO BID, 1st dose now.  Good night.  hangs up

Nurse: to me Don’t you mean E-N-A-L-A-P-R-I-L?  Dumbass.  Too bad he hung up.  That was fun, maybe he could have been a litle more condescening…

Ahhh, smug docs.  Always a favorite.  Especially when they do or say something truly stupid.

Hmm… patient got analipril (snerk), his pressure went down and his chest pressure magically went away.  I love it when you note you’re uncomfortable with a patient’s assessment/orders and the doc says, “I’m not.”  All I can ever think about, but never say is, “Of course you’re OK with that.  You’re not here to deal with it when they go south.”  But I guess when you’re “smart”…

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