It was probably his first time calling a psychiatry consult as an official doctor. The Surgery Intern wasn’t quite sure how to ask the question; he self-consciously fumbled with the words as if they were slippery specimens he had just removed from an abdominal cavity.

It was cute—and, eventually, after rephrasing his question several times, he was able to articulate his question: “We’re wondering if we could get your help with managing this patient’s behavior.”

It’s not the most specific question, but often, it’s sufficient: Something doesn’t seem quite right—can you help us figure out what it is, if anything?

The Surgery Intern had already endeared himself to me with his initial question, but when I called him back with recommendations, I was unprepared to feel so impressed.

“So we’re using This Medication to treat his delirium?” he asked.

“Well, yes, but usually we recommend significantly lower doses for delirium, so that’s why I suggest the taper.”

Tangent: In my experience, the surgeons are actually fantastic at managing delirium, but some tend to be a little overenthusiastic when ordering antipsychotics to manage the agitation associated with it. The general recommendation (on the West Coast; again, this seems to be a coastal thing) is high frequency and low dose; some surgeons end up ordering high frequency and high dose. Consider the example of washing your hands: You wash them (hopefully) at a fairly high frequency—when they are dirty; after you use the bathroom; before you eat—at the small “dose” of a sink for a minute (if that). Now imagine washing your hands during all of those occasions, but in the geyser of an open fire hydrant for fifteen minutes at a time. It’s just too much.

“Oh, I see… so, if I can ask you a question for my own learning—if you’ve got the time—”

I have never heard a surgery intern or resident phrase a question like that!

“—I just read this article about This Medication and increased mortality, but there was also another article by The Big Pharmaceutical Company stating that This Medication doesn’t have an increased incidence of mortality with use. Can you tell me a little bit more about that?”

He didn’t see me smile, but I hope he heard it in my voice.

“So the data about mortality is the most concerning in the elderly…” I began, still in disbelief that a surgeon had asked this question. I should have more faith in my surgical colleagues, yes, but this was clearly an exception—I had met only one other surgery resident in the past who had made a specific inquiry about psychiatric medications. Never mind my fondness for teaching; these questions ultimately help the surgeons take better care of their patients.

“Thank you for your time and help; I really appreciate it,” he concluded.

I was beaming.

I hope internship doesn’t pummel the intellectual curiosity out of him.

What GruntDoc said about “blank” nursing home medication administration records accompanying patients in the ER is true.

It’s terrible for everyone involved.

From the psychiatric standpoint, this further alienates patients with mental health issues (particularly people with psychotic conditions): Other docs may be more likely to assume that the patient’s “altered mental status” is due to any real or imagined psychiatric condition, rather than delirium due to a medical condition. The moment people see antipsychotics or mood stabilizers on the record, some of them may be less likely to pursue as thorough of a medical work-up and, instead, they bark, “Call psych.” Thus, these patients may not receive the prompt medical attention they require. Furthermore, the time we spend in the medical work-up results in time lost for appropriate medical care, as transferring patients from one service (and location) to another often takes much more time than any of us care to admit.

Yes, it’s true: Patients with documented psychiatric diagnoses are often treated differently in the hospital. We feel angry about it, too.

My dad has always loved basketball—these days, more as a spectator, though he played as a point guard for school in his younger days. While I was at UCLA, he followed the Bruins faithfully, often excitedly reporting their progress to me.

The vast majority of our phone calls don’t involve discussions about basketball, but when he gets started, I can hear the enthusiasm growing in his voice. Today, he told me about the NBA draft picks with great interest.

“You know Yi Jianlian?” he started. He didn’t wait for me to answer the question. “He said that he wanted to be in major metropolitan areas with lots of other Asians. That was important to him. I think he said he wanted to be in San Francisco or Los Angeles. You know where he ended up? In Milwaukee.”

“Ouch,” I replied.

“There’s not a lot of Asians in Milwaukee,” my dad continued, “and he doesn’t drink beer.” He started to laugh. “But I think he’s doesn’t have all the right ideas about Milwaukee—it’s fairly liberal out there and they don’t all drink beer.”

He paused.

“But maybe he’s thinking of getting traded to San Francisco or Los Angeles in the future. More Asians in California.”

My dad would be absolutely tickled if either Yi Jianlian or Yao Ming was his son-in-law.

Too bad neither one of them dance! (Never mind the disparities in our ages—especially with Jianlian. Yikes.)