Continuity of Care

So when I'm working in the emergency department, I usually try to take my family medicine hat off, because then I usually worry about my patients at home. Are they going to be okay? Who will make sure that their INR stays at therapeutic level? What happened to the guy we sent to the ICU?

Well I had gotten very skilled at referring patients onto say, medicine or general surgey, and then promptly forgetting about them. Especially if I didn't know what the hell was wrong with them. This one lady came in last week because she fell and couldn't get up. For like 4 hours. And her sodium was 125. She looked like she'd been in a fight too. So I called medicine and said, hey look this woman had a fall and her sodium is 125. I know it's not like a record low, but she needs to come in for a day or so for correction and workup so this doesn't happen again. I mean, we're not going to keep her in emerg for 24 hours. Sounds reasonable, or so I thought. It was the end of my shift and I really just wanted to get out of there.

The person on the other end said, "So, why do you want to admit them?"

Me: "Because she fell? (And because you guys didn't FIX her the last time she was hyponatremic!?!?)"

Them: "Oh okay."

Wow, I wish it was that easy all the time.

Well, yesterday I was looking at some old charts and I came across mine from that lady last week. Turns out medicine gave her a 500 cc bolus of normal saline and then sent her home. Like THAT's going to correct her sodium 10 points. Nice. If internal medicine were that easy I would have gone into it. Please tell me if I am making the wrong assumptions here....