The Boss

My supervising doc called me The Boss about a week ago and has proceeded to occasionally call me boss when I'm in clinic... I do for all intensive purposes run the clinic - with his guidance of course, but I am not the boss of the clinic. So perhaps good readers one can empathize with me in my frustration when I get over ruled to send someone to the ER for a possible ostemyelitis or septic ankle joint. Slightly elevated white count at 13, no osteomyelitis on the xray - just evidence of an old fracture, no abscess, and a couple pieces of hardware. The ankle is now warm, red, pt is afebrile, still weight bearing, and is no other medical concerns(transient HTN) but I know if I saw this person in clinic - I would send them straight to ER. But in my setting we do things a smidgen different - the object is not to send them out, do as much as we can in house as it poses a threat to the community, the hospital and officer safety for people to go from our facility to one in the "free world". I may sit on a chest pain until troponins are sent back and read elevated from a stat lab, despite not having any change on the ECG. I wait on a hyperkalemic patient until they are above 6.2 - even though at 6 they can have fatal ectopy, not sending someone with lower right abdominal pain with a fever until blood work is back and a KUB, which both turn out to be normal. It's a slippery slope and an awkward phone call to a seasoned professional to say doc, I think the pt needs to go, because I am uncomfortable and you have not seen the patient, the command staff is asking me to override you.

In light of the not 1 but 2 or 3 contorted articles in the paper about a particular facility, I cringe knowing there is a slippery slope being a PA, using my best judgement but working and consulting with a physician - someone who is seasoned to make the best decisions to present to the patient. This is the one and only time I have thought to myself, I wish I were the doc right now.