Working with ID teams

I wrote most of this post a few weeks ago (i.e., in August), but never got around to finishing it. I'm back at the "main" hospital for this month, but I wanted to share this anyway.

Aside from the occasional call for a mislabeled specimen or to discuss inappropriate use of lab resources (see below), the only real clinician interaction we have on our microbiology rotation is with the ID (infectious disease) team. As I mentioned in a previous last post, I am at a different hospital this month than I was in July, and man, what a difference a ten-minute shuttle ride makes.

At our "main" hospital, rounds start every day after lunch. The ID attending and fellow are always there to join us. As a result, we discuss cases in depth, with the clinicians knowing everything about the patient's hospital stay and the pathologists discussing the lab findings and their implications. It makes rounds longer but more interesting, as the case becomes more than "this plate grew out some weird bug." The patient becomes a person with a story, not just some lab results. It's easy to get into this mode of thinking when you're tucked away in the hospital lab, and talking with the ID folks about cases really reminds you why you're doing what you're doing.

In contrast, I have yet to see a non-pathologist in the micro lab I'm at this month. The ID team is apparently too busy to make rounds in the lab (I don't mean that sarcastically; with the patient population we have here, they certainly have their work cut out for them). This means that, for the most part, the patients exist as names on specimens, or data in a computer chart. I will occasionally research the clinical presentation of an interesting patient (like last week's Rhodococcus patient) and even go to the floor and look at the chart, but it's not the same as having a knowledgeable clinician discuss the case with you. Fortunately, while I'm on the floor, I can usually find a nurse or resident involved in the patient's care, but I had to go to them, not vice versa.

I've only even heard the term "ID consult" once this month. We wanted to suggest one to a doctor who has been swamping the lab with specimens. He has seemingly cultured his patient's one wound in three separate locations, twice a week, for the past two months. The computer can't even pull up all the lab results without crashing. And the results always show the exact same bacteria with the exact same susceptibility profiles (i.e., they never change in terms of what antibiotics will kill them). This patient has been put on a few different antibiotics, but nothing seems to change. This doctor is apparently upset at the lab, and we're not too happy with him. I feel like I am missing something, but I have gotten as involved in the case as I can, and I'm still confused. Hence recommending an ID consult to sort things out. I just hope that actually happens, and since we never see the ID doctors face to face, it's harder to get everyone working as a team, since we're all just names on a pager to each other.