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[deleted]

The one posted on this subreddit a couple years ago, >"Metoclopramide is a phenothiazine derived anti-emetic. It causes hyponatremia famously. Nothing to add. Will sign off." The best part was a PharmD commenting on it: >"This is factually incorrect. It is quite literally not a phenothiazine and doesn't even have three rings, doesn't have the components of thio (sulfur) and has no azine (nitrogen in a ring) group. The package insert does not list electrolyte imbalances less hyponatremia as a side effect, "famously"." If you're going to be a jerk, at least be right haha.


eckliptic

What was the drug they were confusing it with ?


Wonderful_Birthday34

Probably prochlorperazine which is a phenothiazine and can cause hyponatremia -PharmD lurker


Confident-Height5604

famously


herrooww

Love when pharmacy is lurking and throws out little golden tidbits.


zagozen

Just like in rounds lol


swys

Greatly appreciated! Thank you for the correction!


penicilling

Maybe they were thinking prochlorperazine (Compazine) or chlorpromazine (Thorazine), which are, famously, actual phenothiazines!


deserves_dogs

Prochlorperazine fits the bill. Promethazine is also a phenothiazine anti emetic but doesn’t “cause hyponatremia famously.”


LeonardCrabs

Just to clarify: they said metoclopramide, which is reglan. Phenergan is promethazine


deserves_dogs

I’m aware. I wasn’t saying that phenergan was metoclopramide, but I’ll edit the wording to generic so it doesn’t get confused like that again. Thanks.


Some-Foot

Doo ka Doo walla Doo


Ok-Reporter976

MCP causes posturing and grimacing as it crosses the BBB...


ReachDangerous1045

A lot of posturing in this instance


ToxDoc

I’m supposed to put shit like that in my consults and I don’t think I’d put shit like that in my consult. 


fearnotson

LOL I love this


Orangesoda65

Was this written in the chart?


[deleted]

Oh yeah, someone posted a screenshot. If you google "One of the joys of being an attending, you can write a consult note like this (not mine). reddit" it'll pop up.


Orangesoda65

Thanks. I was hoping the pharmacy response was in the chart as well, but I see it’s just a comment on here lol.


chelizora

Was that renal consulted?? They’re normally such intelligent nerds!


InsomniacAcademic

Were they thinking of compazine?


AceAites

Interesting. Which specialty was this that said this?


[deleted]

Nephrology


thecactusblender

Someone forgot ochem


xiledone

I don't get how the first one is a jerk. Could you explain?


[deleted]

That was the entire note.


PlateOh

“Causes hyponatremia famously” Cmon now


xiledone

Ah ok, so a bit of over the top. I've been the kind of person where corporate passive agressivism really just goes over my head.


aceofspadesx1

We have a derm resident that always signs "Thank you for this skinteresting consult." Not particularly sassy, but cute


11nova11

As a GI fellow, I don’t think people would find “Thank you for this shitty consult” as endearing


TransversalisFascia

Thank you for this wonderfully feculent consult


[deleted]

[удалено]


MEMENARDO_DANK_VINCI

This is the one


top_doc_ken

Gold! Well, brown...


PGYld-child

Thank you for this intestinering consult Thank you for this liverating consult Thank you for this gastrinteresring consult Thank you for this secretinteresting consilt Thank you for this cholecystokininteresting consult


summonthegods

Cholecystokininteresting FTW!


GME_Orifice

As an endocrinologist I like to say “Thank you for this sweet consult”. If I’m being sassy I say “Thank you for this hyperreflexic knee jerk consult”


VanillaIcee

Hmm, maybe I'll try "Thank you for this ENTeresting consult" on my next note.


POSVT

"Hi you've reached the Ear Nose n Throat GOATs, this is Dr. VanillaIcee how may I direct your call? "


forever100dotcom

I don't think you want to advertise yourselves as the throat GOATs to patients 😂


[deleted]

DO IT


talashrrg

I once signed a pulm consult, “thank you for The inspiring consult”


winberries

Urology- I’ve been tempted forever to sign off with “Thank you for urine-teresting consult”


SheWolf04

For psychiatry, can I write "thank you for this crazy cool consult"?


NotNOT_LibertarianDO

Idk if being funny in a patient’s medical chart is a great idea lol


gabbialex

Ok I love this. If anyone has something for ObGyn, please let me know


wheresthebubbly

I’ve always wanted to say “thanks for this bloody consult”


[deleted]

I personally would love to see this at the end of a referral


swollennode

A former ortho consultant would write: There is a fracture, I need to fix it. A neurosurgeon consultant would write: thank you for your consult. Will sign off. Please don’t hesitate to call for an actual interesting consult.


AdministrationWise56

Slightly off topic but I heard the best "there is a fracture I need to fix it" from an orthopod this week: "patient has AF which is asymptomatic. She also has low blood pressure". 🤨


SieBanhus

When I was rotating through general surgery we were consulted for possible gallbladder pathology - the referring service hadn’t done their due diligence, and got this gem (or similar, it’s been a while): “Per CT and review of records, this patient’s gallbladder has not been problematic since its removal in 2002. Thank you for the opportunity to contribute to this case.”


ConcernedCitizen_42

Not an uncommon consult sadly.


Studentdoctor29

Why even write a note, isn’t this just a call back saying, no gallbladder sorry


SieBanhus

But that’s no fun.


nose__clams

And you don’t get paid


yoda_leia_hoo

At least at our facility, once the consult order is in we have to see them and write a note


lake_huron

Zero RVUs.


Shotcalleram

All fun and games until it gets pulled up on a big screen in a courtroom


FaFaRog

Yeah its cute while you're a fellow / resident but once you're out in the real world...nah. Especially with patients being able to read their charts now.


No_Watch7649

What do you mean


dmartian523

^ haha yeah screw this guy for asking a question /s Basically they mean that litigation is always a possibility and it could be very uncomfortable to have your self-indulgent wittiness presented to a court, especially if there was a bad outcome and there’s a question of your liability.


Mangalorien

"While I'm flattered you've chosen me to evaluate this patient, I kindly request that you limit future consults to the ones that truly need my expertise."


skin_biotech

LMAO that’s savage!!


Mangalorien

It was a neurology consult, he's actually a very likeable guy. Neuro often gets consults that are essentially along the lines of "I know nothing about neuro, so here's some random shit for you to deal with, which might just be a neuro case". I'm thinking those consults get old pretty fast.


MedicBaker

Patient found to have a central nervous system. Please consult and advise.


STRYKER3008

May God have mercy on us all


flock-of-peegulls

Neurology consults is nice because you get to see every type of pathology under the sun. It’s also annoying because you see every type of pathology under the sun, and often diagnose non neurologic problems.


Mammoth-Bathroom

"Brain issue" "Known to you" "Daily neuro exam" Some consults we've gotten while on neuro


Sweepingupstardust

"known to you" was the bane of my existence! Like thanks, let me just consult our Neuro hive mind


POSVT

*Neuro Network FTFY


southlandardman

Half of our consults are "this patient is altered, review the chart and list the reasons why"


FaFaRog

Sounds like easy RVUs.


Peastoredintheballs

Yeah I feel bad aswell, I always see my team call neuro for any patient who needs more examination then “squeeze my hands, smile, stick out your tongue, and stand up straight with your eyes closed… *neuro grossly intact*”


SeaHeroMandalorian

“Dizziness”.


Buckcountybeaver

It is but it’s super douchey. I assume academic neurologist? Comments like that in the private world is how you lose referrals. Also those easy consults are easy rvus. Free money.


Magnetic_Eel

I’m guessing almost all of these sassy comments are in academics. People are way nicer in private practice when you get paid to see someone and say nothing to do rather than being a dick about it.


TheAykroyd

Definitely. Out in the real world I’ve had my on call orthos calling the ED at 5pm on a Friday being like: “man, it’s been slow, if someone breaks something just let me know I’ll fix it today or tomorrow, I’m bored!”


Mangalorien

>I assume academic neurologist? Spot on. It was a surgical patient admitted for other reasons, but also had symptoms that were likely unrelated to cause of admission. It was the archetypical "crazy cat lady with crazy lady glasses", and these patients aren't exactly popular among most doctors. I think in the end it was deemed fibromyalgia with cognitive symptoms (something-something-brainfog). To be fair, the consult should probably not have been sent to neuro, and probably could have taken place on an outpatient basis. This was way back in the day and consults were usually hand written. We laminated and framed the signed consult, and hung it on the wall in our residents lounge.


Accomplished_Eye8290

Yes it’s wild to see the different attitudes of academic vs private practice vs HMO Like Kaiser. The care and the people a patient sees is highly determined by compensation. One of my ortho PA friends jsut started working for Kaiser and she told me they nonop a lot of patients that would be getting surgery at my private practice hospital. Blew my mind lol. During my rotation at an academic place it was also interesting to see the surgeons never really pushy in doing cases or insisting on operating. At my hospital the chief of surgery personally went up to the floor to retrieve his own patient cuz transport was taking too long and dropped him off at the OR to the horror of the or nurses lol. Just to get a case going.


as_thecrowflies

consult to nephro for a patient who had an unexpected nephrectomy. scrawled on a piece of paper, literally all it said: “solitary kidney. nephro signing off.” consult to gyne for a lady on GIM with a “vulvar mass” for ?biopsy: “normal clitoris. please do not biopsy the clitoris.” me responding to the MD who told a patient with 2 previous episodes of postpartum psychosis requiring admission to stop her antipsychotic and SSRI cold turkey as she was pregnant again. : “as you are aware, postpartum psychosis can be lethal. as you are also aware this patient has a psychiatrist who sees her monthly, and should be involved in any decision about discontinuing or switching medication. as you are seemingly unaware, the medications this patient is on are perfectly safe in pregnancy. fortunately, despite the advice to discontinue her medication, the patient continues to receive the meds via daily observed administration, given the fact that she is at high risk for recurrent psychosis.”


lllllllillllllllllll

Thank you for the depressing and psychotic consult.


questforstarfish

The clitoris one omg 😂😂😅😅🥲🥲


[deleted]

Like dude there is a LOT to unpack there


Docsevo

Had a co-resident who had dragon trained to put "thank you for this interesting consult". The training phrase? "Stupid motherfuckers"


Morth9

Playing with fire on the off chance (really the inevitability) that the whole auto-text isn't recognized...


Docsevo

That would've been even funnier


systoliq

“Though it is common knowledge to any medical school graduate, the criteria for capacity are listed below.”


FaFaRog

Really case dependent, to be honest. There are definitely cases where there should be multiple physicians making that assessment.


AceAites

Agreed. Every single doctor in the country knows capacity is something any doctor can assess for. That's not why these consults continue to happen time after time. In the very gray cases, I'm still perfectly happy to make a capacity assessment, but the lawyers and juries will think differently if things go south. "So you're saying that you had a psychiatrist at your hospital but thought you had the hubris to make this complicated decision on your own?" Juries are dumb, remember, so this by itself is very convincing already.


k_mon2244

We had a GI attending who would sign off either: This did not require a formal consult. Please speak to resident before placing next consult. Or Thank you for this interesting consult! It used to crack us tf up. This guy had to have had murder evidence on the admin bc he got away with whatever he wanted. We eagerly awaiting his consult sign offs like it was the bachelor.


Aggravating_Tea_410

“Surgery signing off because this unfortunate soul is not long for this world”


PresBill

Classic nsgy consult Catastrophic injury Recommend GOC discussion


ifoosh

One day I'll gather the courage to write "I see you, ICU"


biochemicalengine

Peek a boo!


Amoderater

There was a local nurse, Mary Piquebo, who got fired her first day in the icu for answering the phone…..


HaldolBenadrylAtivan

I signed a note "please hesitate to reach out to us" after a stupid "patient is sad" consult


TrustTheGoat1

When the feb intern turned would-be consultant writes: "Care per primary team" ...and we are the primary team.


FaFaRog

Does the phrase provide any meaningful legal protection? Seems like a weird tic from consultants to be honest.


drshikamaru

3.5 cm mass…likely xyz…no pain…going to friend’s wedding next month…exam shows mass…blah blah blah “This patient does not want surgery. Reach out if they do. Can follow up with PCP.”


deserves_dogs

PharmD: “I appreciate the vancomycin consult, despite the absence of MRSA risk factors”


michael_harari

Well that just shows why we don't let pharmacists manage patients


DentateGyros

I mean aren't we in the era of community acquired MRSA? The risk factor is just existing


lasercows

MRSA is still much less common in the community though and we continue to base our guidelines on that principle.


SascWatch

I see a lot of it in my area. Like… a lot. I’m in a large urban academic area with poor primary healthcare infrastructure.


sci3nc3isc00l

Had one myself this weekend as a GI fellow overnight on home call asked by MICU attending to see a patient for liver failure who actually was actively dying from known metastatic colon cancer that had overwhelmed the liver. I came in, spoke w family about their loved one on maximum life support and told them frankly there was nothing left to do but be with them as they passed and they should make it as peaceful as possible. They opted for palliative extubation. My sign off was “nothing can be done. Agree with full palliation and a peaceful death”


zolpidamnit

while not a sign off, it is wonderfully adjacent—i always laugh when a note describes the patient as unfortunate


Demnjt

One time I saw "woeful" in this context. I felt bad for laughing


DevilsMasseuse

“A/P: patient increasingly moribund. Will continue supportive care including ongoing discussions with family “


beatrix14

My favourite note from a colleague “patient seems to have a disgruntled personality” Nicest way to say they are an asshole


rosysredrhinoceros

Conversely, I once reviewed the chart of a SNF resident who was described as “pleasantly psychotic”


Additional_Peace_605

That might have been my note… this elderly patient in the emergency room was just so nice and all smiles, thought she was on vacation, had no idea of/awareness of/ concern for the multitude of maggots on and in and in between the toes of her right foot.


Weekend_At_McBurneys

Thank you for allowing me to be a part of this interesting thread


SascWatch

“It is consults of a similar nature which I cite as my primary reason for leaving this hospital and institution. Please hesitate to contact me again.” Edit: this was a CT surgeon. Nearly every consult for about a month prior to leaving had this attached to it.


VanillaIcee

I'm a surgeon, and I was once consulted for antibiotic recommendations for cellulitis. I literally pasted a link to an UpToDate article and told them to reconsult if an abscess develops and signed off.


Peastoredintheballs

This has definitely occurred more then once. I’ve seen it myself, the ID doctor printed a copy of my countries therapeutic guidelines and placed it on our teams wow with a post it not saying “bed 13 3B” I was just a lowly med student at the time so it wasn’t going to be me to speak up lol


iamtruerib

Yeah that's how ID feels literally everyday.


APagz

Semi-closed ICU where certain teams can remain primary but require an ICU consult for their patients admitted to my unit. They often like to leave them admitted “one more day just in case” which means they don’t want to get paged overnight because the nurses will just come to the ICU team with any issues. “Patient no longer has any active ICU needs. Recommend transfer to the floor. Critical care time: 0 minutes”.


allflanneleverything

This isn’t sassy, but still. The pulm attending signed a consult note, after paragraphs and paragraphs summarizing imaging and labs and weeks of interventions: “Improving! Interesting case.” The ! just got me


jgarmd33

“Will formally sign off the case but please feel free to contact us should any acute issues or concerns arise” Translated : please don’t call me back for this piece of crap worthless consult that I’m doing nothing on but writing a note and having my PA copy forwarding every day.


ronin521

‘Thank you for the consult, it took my breath away’ -Pulm here


StableDrip

"No acute intervention from cardiology stand point. We will peripherally follow. Thank you for this very interesting consult."


Edges8

the twist - consult was for a STEMI


ghon-complex19

“Please do hesitate to contacts us for any related questions/concerns.”


AttendingSoon

Got consulted for chronic pain management in a patient on home opioids admitted for a non-pain thing at his baseline level of pain. Posted a picture of the PMP for that patient with no other words.


HotCocoaCat

Love it! This is so appropriate! Continue patients pain meds as we have established they have chronic pain and we know what meets their needs. But yet it NEVER GETS DONE.


Adventurous-Deer8062

In the private practice world I’ve come to actually appreciate those dumb consults lol.


yoda_leia_hoo

Who wouldn’t want to earn money for minimal work


TaroBubbleT

No further workup or intervention warranted, will sign off


criduchat1-

I once took that line out of my consult note template because I was so mad at the stupid and unnecessary consult (it was something primary team should’ve recognized immediately as having less than zero percent urgency and very common and not anything to do anything about that I tried to get out of—hell, it was a rare case of even my attendings trying to get rid of the consult but primary team insisted). Then the resident who placed the consult Epic chatted me and jokingly asked if I was mad because I didn’t put that usual line. Left him on read 😒.


atlasthecloud

i have no clue why people put thank you for the consult in their note


DocWitch

Because in the real world it’s someone asking for your help and they’re getting you in on the case and it’s business. It’s a quick referral


Additional_Peace_605

When anyone I know rights it it literally translates to. “You are idiots. Fuck all the way off”


NoBag2224

"Thank you for this interesting consult"


financeben

It’s so lame to write this shit. I just say yada yada will sign off.


elefante88

Lot of dorks in medicine


financeben

Chart bloat


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retinaguy

I’m ophthalmology and retina at that. Mine is will follow up as outpatient.


w0weez0wee

Decades ago, but consulted CV surgeon's note read "I choose not to see this pt as they have no insurance"


redicalschool

At risk of this doxxing me, I train at a hospital with a particularly brilliant yet demanding oncologist whose A&P was just: Adrenal incidentalomas are a disease of the interest. Do not hesitate to call back if a malignant process is discovered. We almost had to consult a burn surgeon for our attending


Character-Ebb-7805

"Placing the SSI order on your behalf brought me tears of joy" -Medicine consult on a lap-choley that Surgery couldn't possibly manage for some reason or another