{"id":2309,"date":"2017-08-23T16:34:45","date_gmt":"2017-08-23T20:34:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=2309"},"modified":"2017-08-29T16:23:05","modified_gmt":"2017-08-29T20:23:05","slug":"is-transferring-a-patient-to-the-icu-a-failure","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/","title":{"rendered":"Is Transferring a Patient to the ICU a Failure?"},"content":{"rendered":"
\"Cassie<\/a>

Cassie Shaw, MD, is a 2017-18 Chief Resident in Internal Medicine at Saint Louis University Hospital in Saint Louis, MO<\/p><\/div>\n

As I sit with one hand wrapped around a greasy diner cheeseburger, eating my feelings \u2014\u00a0I mean, my dinner \u2014\u00a0it sure feels like failure. It\u2019s 7:22 pm, and the first patient with my name listed as the attending is being packed up to roll into his new room in the intensive care unit. Did I mention it\u2019s my first week on service? Okay, so I\u2019m probably being dramatic, because the patient, although very ill, is only going to the ICU because he needs closer monitoring for the next 24 hours. However, this was my exact biggest fear as I began attending. In the scenario that plays out in my head,\u00a0it\u2019s a missed diagnosis that is obvious to everyone else;\u00a0the patient has decompensated due to my mismanagement, a rapid response has been called, and I hang my head in shame while my patient is urgently transferred for higher care. I know I\u2019m not alone in this fear. As I reflect on this feeling, I have to ask myself several “why” questions:<\/span><\/p>\n

\"cheeseburger\"<\/a>

Confession: I don’t actually regret this delicious cheeseburger<\/p><\/div>\n

The first “why” is “Why is it so hard to give up the care of a patient to another physician?” ICUs are designed for taking care of patients that are too sick, too needy, too unstable for the floor. Even in a closed ICU, those physicians are our colleagues. I\u2019m currently practicing at the hospital that houses my residency, so the residents who will be taking care of my patient are physicians that I worked beside for years. I know them, I trust them. Further, the ICU attendings are physicians that helped educate me for the last 3 years. I know them too, I trust them too. Is it pride that ties us so tightly to our patients, then? Maybe. But more so, I think we simply want to be *the one*. We want to be the one who gets the satisfaction of making a diagnosis, we want to be the one to help the patient. It\u2019s satisfying work, and it\u2019s why I chose Internal Medicine, where I get to be the primary team; the team that gets to be the one. However, it\u2019s important to remember caring for a patient never takes place in a bubble. It requires teams of nurses, social workers, care partners, custodians, kitchen staff, pharmacists, therapists. I readily accept the assistance of those individuals on every patient, and I need to learn to more easily accept the assistance of my colleagues without feeling like I\u2019m going to lose that \u201cthe one\u201d high.<\/span><\/p>\n

\"steak<\/a>

This buttery, garlic steak and heart of brie were not Band-Aids for worrying about a patient, but they will work to calm fears.<\/p><\/div>\n

The next “why” is “Why am I worried about having to use the ICU?” Well, as I implied earlier, I think this is a projection of my fears that I might a bad physician. In medicine, we are used to\u00a0constant, out-loud comparisons to one another: test scores, mid-rounds pimp questions in front of our team mates, even our notes outlining our thought processes are up for judgement by colleagues. In fact, just tonight, I wrote an addition to my residents\u2019 transfer note to further explain why I had broadened antibiotics \u2014 because I knew my management would be scrutinized by the ICU team. Although stressful, and driving my diet into the ground, I think this fear can be beneficial when used wisely. Cheesy as it sounds, this fear forces me to double and triple think my decisions. The mismanagement scenario was definitely playing through my head as I ordered the\u00a0chest CT,\u00a0sealing his fate to move to the ICU. Without that fear would I be as careful? Would I be as thorough? Would I be as thoughtful? As I write this, it\u2019s occurring to me that maybe this \u201cfear\u201d isn\u2019t lack of confidence; it\u2019s care for the patient\u2019s outcome. <\/span><\/p>\n

\"Cassie<\/a>

St. Louis style ribs from Pappy’s and Urban Chestnut craft beer work for both celebration and guilt. No excuse needed.<\/p><\/div>\n

Going forward, I have no doubt I will have\u00a0patients whose diagnoses I will miss. They will unexpectedly decompensate, and they will end up in the ICU. When it happens, I\u2019m going to get my physician high from knowing that I helped the patients get to the level of care they required. Until then, I have to remind myself that my nervous, churning stomach that can only be quieted with high-calorie comfort food is, in fact, a surrogate marker for me wanting to do right by the patient. Well, that, or a peptic ulcer.<\/span><\/p>\n

 <\/p>\n

\"NEJM<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

As I sit with one hand wrapped around a greasy diner cheeseburger, eating my feelings \u2014\u00a0I mean, my dinner \u2014\u00a0it sure feels like failure. It\u2019s 7:22 pm, and the first patient with my name listed as the attending is being packed up to roll into his new room in the intensive care unit. Did I […]<\/p>\n","protected":false},"author":1286,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[13,29,31,33],"class_list":["post-2309","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-attending","tag-internal-medicine","tag-patient-care","tag-reflections"],"yoast_head":"\nIs Transferring a Patient to the ICU a Failure? - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"New attending physician Cassie Shaw considers the source of her fears about transferring a patient to the ICU\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Is Transferring a Patient to the ICU a Failure?\" \/>\n<meta property=\"og:description\" content=\"New attending physician Cassie Shaw considers the source of her fears about transferring a patient to the ICU\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2017-08-23T20:34:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2017-08-29T20:23:05+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2017\/08\/Cassie-Shaw.jpg\" \/>\n<meta name=\"author\" content=\"Cassie Shaw, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Cassie Shaw, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/\",\"name\":\"Is Transferring a Patient to the ICU a Failure? - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2017-08-23T20:34:45+00:00\",\"dateModified\":\"2017-08-29T20:23:05+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/fbc098d709ca82cba95bd69e01234ebe\"},\"description\":\"New attending physician Cassie Shaw considers the source of her fears about transferring a patient to the ICU\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2017\/08\/is-transferring-a-patient-to-the-icu-a-failure\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Is Transferring a Patient to the ICU a Failure?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/fbc098d709ca82cba95bd69e01234ebe\",\"name\":\"Cassie Shaw, MD\",\"description\":\"Cassie was born, raised, and educated in Kansas, including earning her Bachelor\u2019s Degree at Pittsburg State University and her Medical Doctorate at the University of Kansas School of Medicine. 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