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Communication with Other Groups
There are two pillars of skill needed to work well in the hospital: clinical knowledge and communication. You can have all the knowledge in the world, memorize the ICU book from front to back cover but if you aren’t able to communicate your thoughts you won’t be able to apply this knowledge. This includes being able to communicate with other groups in the hospital.
Realistically there will always be other groups in whatever hospital you go to. While some of these groups may be more specialized, e.g. cardiology or surgery, others may be closer to what we do (internal medicine docs, locum docs in the COVID unit). Each group will have a complex and longstanding relationship with our group that is there before you even start. Part of being able to practice medicine and help people will be integrating yourself into this relationship and getting to know the other groups so you can get things done more efficiently. As time continues, this regular and effective communication will translate into mutual respect and ultimately help you form relationships with your colleagues around you.
While this is an ongoing skill that you will have to be constantly developing, we have included some tips to help you better know the expectations in the hospital.
If you are consulted on a patient, make sure you let the group who consulted you know the final disposition of the patient. You will see this isn’t done as much with ED patients, IMS patients etc due to overall hospital culture being that the loop isn’t closed - so doing this will make you stand out as a communicator. For groups who don’t consult you as often, e.g. a surgeon, you should absolutely close the loop and let him/her know if you will be bringing them.
If a group is primary on a patient, every move you make should go through them first. If the GI team came into the ICU and started ordering a bunch of stuff on a patient we were primary on, we would be incredibly upset. This can be tough to navigate when patients are in shared ICUs but is important to do so you do not make it seem like you are crossing boundaries. A good example is if the nurse on the floor calls you about an IMS primary patient saying they need an order- you tell the nurse to call the IMS provider and stat team (if needed), then you call the IMS provider yourself and explain the situation. We also commonly encounter this with cardiology, transplant and surgical patients. No matter how small the order you’re placing you should always let the primary team know.
If you are ordering something that will affect the patient in a way that the consulted group would care, it is courtesy to let them know and get their input. You shouldn’t order subcutaneous heparin on a surgical patient unless you’ve ok’d it with the surgeon, you shouldn’t order a diet on a GI patient unless they’ve been cleared by the GI team to eat, and you should speak to nephro before diuresing someone in volume overload if you consulted nephrology to help with volume management. While in emergent situations you must do what you must do, if you have time you should try to and have a conversation with your consultants first.
If you tell a group something and it changes it is very kind to let the consulting team know. If you call nephrology for CRRT then the family decides to withdrawal, it is kind to tell the nephrologist that there has been a change in plans if you can. This can be as simple as texting or calling them.