Verify

We live in an age of mistrust, and perhaps one of the greatest mistrust is felt by those of us with busy lives at work.

This idea began to dawn on me during recent conversation among our medical colleagues who complained bitterly about urgent consultation to see patients outside our department. It can be somewhat frightening to think about the mushrooming consultations within a hospital nowadays. Never in the past were doctors confronted with endless consultation to see patients from other departments (which, mind you, keep increasing in number and variety). The consultations come in many guises. Some of them are darn real urgent, some less so, the others being trivial and almost meaningless.

One of the most difficult tasks is to find out which is which.

Last week, my nephrology trainee brought me to see a patient who had just undergone a surgery of cancer at his neck; he has kidney disease and is on dialysis. "It should be a straightforward case," I thought.

Not until I met the patient did I realize that he had a metallic heart valve. Which means he needs to take anti-clotting medication to stop his metal valve from getting blood clots and hence damaged. Alas! His usual oral anticoagulant (or blood-thinner) medication was simply discontinued without any bridging anti-clotting medication like heparin for almost one week. In case you're wondering whether the surgeons had consulted the cardiologist for opinion, here is the answer: Yes, they did. The consultation letter asked for opinion about the medication before and after the surgery, but never mentioned that the patient has a metallic heart valve. The medical doctor then turned down the request to see the patient and wrote back to the surgeons, asking them to refer this patient for opinion at the outpatient clinic.

In no sense do I mean to say who's right and who's wrong. Difficult to grasp as it might seem, I have always had difficulty in turning down a consultation without either seeing the patient or talking directly to the doctor who makes the consultation request.

My colleagues are no doubt tired of my favorite quotations, including that signature phrase from Ronald Reagan. To which may I add here, "Mistrust, but verify."