https://orcid.org/0000-0002-0354-4586
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Bo Wang, David Svec, Physicians and blocking: can we tear down this wall?, Postgraduate Medical Journal, Volume 93, Issue 1106, December 2017, Pages 777–778, https://doi.org/10.1136/postgradmedj-2017-135115
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Patient case
A patient was brought to the emergency department (ED) by family complaining of chronic headaches and a question of new neurological abnormalities. A week prior, this patient had been hospitalised at a nearby institution and diagnosed with a large intracranial tumour with associated bleeding, with plans for neurosurgery follow-up after discharge. Imaging in the ED confirmed the haemorrhaging brain tumour; images from the prior hospitalisation were not available for comparison. The neurosurgery service was paged for admission but deemed that emergent surgery was not indicated and thus declined to admit the patient to their team, though offered to serve as a consultant. However, they also did not recommend discharge. The neurology service was then paged for admission but after evaluation declined because of the haemorrhage associated with the brain tumour. The oncology service was then called to admit, but per policy deemed it inappropriate to admit a patient with a primary brain tumour to their team. An ED change of shift occurred, neurosurgery was paged again, and on repeat assessment deemed the patient suitable for discharge with follow-up at the previously scheduled clinic appointment. Hours had passed between the initial admission page and discharge.
