I don’t think my memory is failing me, nor do I believe that it is simply a function of the time of year—I really think residents are nicer this year. And by “residents”, I mean all the residents in the other medical specialties who request psychiatric consultations for their patients.

General surgeons, unfortunately, receive the worst reputations when interacting with other services. To be fair, the surgery interns are juggling upwards of forty patients on their lists during the height of trauma season—which is now. They’re stressed out for good reasons and, in an effort to maximize efficiency, may become brusque with other human beings. It is what it is.

Internal medicine residents are probably next in the reputation queue—though they, too, also get stressed out for good reasons as medicine is the default service for “social admits” (the term used for people who are experiencing medical conditions that do not warrant acute hospitalization, but they have nowhere else to go). Furthermore, medicine often receives patients who carry medical diagnoses, though their acute problems may be surgical in nature. Consider the aging male with high blood pressure and diabetes… who fractured his leg when a car ran into him. There may be minimal problems with his blood sugars and blood pressures, but he still goes to medicine despite the fact that the primary issue falls under the purview of the orthopedic surgeons. This “dumping” induces bitterness and cynicism amongst the medicine residents (and facilitates the ire they may feel towards the surgeons… and this is how medical specialty supremacy blooms).

Thus far, people have been really nice about calling consultations. In years past, exchanges occurred like this:

Surgeon: Hello.
Psychiatry: Hi, this is Maria from psychiatry returning a page.
S: Yeah. I’ve got a 34 year-old guy, self-inflicted stab wound, had an ex lap last night, missed all the major stuff. Can you see him and take him off of our service?
P: Um… what’s his name and hospital number?
S: (mumbles the information) All of his issues are psych now. Can you transfer him to psych today?

Or like this:

Internist: Hello.
P: Hi, this is Maria from psychiatry returning a page.
I: So I’ve got this 47 year-old woman with diabetes who overdosed on a lot of trazodone last night after getting into a screaming match with her boyfriend. She’s medically cleared now. Can you take her?
P: Uh, what’s her name and hospital number?
I: (crisply recites the information) Her diabetes is fine. There’s no reason why she needs to be on our service now.

These days, I’m getting phone calls like this:

Surgeon: Hello.
Psychiatry: Hi, this is Maria from psychiatry returning a page.
S: Hi… thanks so much for calling back. We could really use your help with a patient on our service. His name is Joe Schmoe, number 1234567. He’s this really nice 42 year-old guy who was hiking out by Index. He ended up falling off the side of the trail and sustained a ton of fractures (which the surgeon would fully delineate here). He made a remark to the nurse that he wanted to die. He hasn’t said anything to me, but we’re all pretty worried about him. Can you help us out?

Or like this:

Internist: Hello.
P: Hi, this is Maria from psychiatry returning a page.
I: Hey. Thanks for calling back. So we’ve got this 76 year-old woman—her name is Ada Beta, number 7654321—who has a whole bunch of medical problems (which the internist would fully delineate here) along with a few decubitus ulcers and a urinary tract infection. She thinks she’s on a boat headed to Hawaii and she keeps trying to get out of bed to wave good-bye to some guy named Horace. Can you help us calm her down? We could really use your help; we’re worried that she might actually fall and break her hip.

I even had a surgery resident say the following to me:

So I’ve got this other person that you may want to see—let me just tell you about him first—don’t write anything down yet—but I should go back and ask him more questions.

That doesn’t seem like a big deal, but it is the rare surgery resident who offers to go back to speak with a patient for more information. Unfortunately, some surgeons recruit the psychiatrists to engage in the doctor-patient relationship with their patients so they don’t have to. (… just like some surgeons ask the internists to follow blood sugars so they don’t have to… or internists ask surgeons to work up abdominal pain so they don’t have to… and so on.)

I’ve shared my observation with my fellow residents and they cynically remark that all of this niceness if simply because it is August—people aren’t bitter and burned out yet. However, I’ve been a resident for three Augusts now and, in past Augusts, people were not this civil and thoughtful.

I love it.

It makes patient care much more effective. It’s much easier to coordinate patient care when people aren’t angry—directly or indirectly—with each other. The focus is clearly on what is the best way we can help the patient and not on who we should blame for the fact that the patient is in the hospital in the first place. (”Well, if only the psychiatrists actually gave him the right meds, then he wouldn’t have tried to stab himself.” “Well, if only the surgeons had kept him longer after his surgery, then his wound wouldn’t have gotten infected.” “Well, if only the internists had actually called us sooner, then maybe we could have intervened earlier to prevent further obstruction of her small bowel.”)

Patients aren’t dumb and are aware when the armies of doctors aren’t getting along. Particularly when doctors are arguing with each other just outside of the patient’s room. With the door open.

Furthermore, this kind of communication works: We are all more likely to help each other out when we ask nicely. We pursue our objectives and maintain the relationships. This is the stuff that makes our jobs rewarding. Patients in the hospital almost never have one doctor; it’s rewarding for all of us to see that our recommendations and interventions are helping to (1) get the patient stable and out of the hospital, (2) make the lives of our fellow residents easier, (3) give hope to the patient and the various teams, and (4) make the day unfold as pleasantly as possible.

Perhaps, this year, we’re all doing a better job at positively reinforcing civil behavior—I know I’m certainly enthusiastically thanking the other residents a lot more than I have in the past for the graciousness they demonstrate when speaking with me. Maybe we’re all tired of dealing with ornery types who ooze misery and are trying to change the system, one consult at a time.

Or maybe it is just still early in the year. Maybe we’re all still naive, idealistic, and hopeful. Maybe we haven’t had enough experience yet to know better.

You can clearly tell which scenario I hope is true.