A medical Pontius Pilate…..

BMJ 06 July 2002       Cite this as: BMJ 2002;325:51

To paraphrase La Rochefoucauld, “There is something in the misfortune of other doctors that is not entirely unpleasant.” Just as with a tip for the horses, the responsibility for advice lies not with the donor but with the recipient; words are cheap, and ultimately it’s your choice whether to act on them or not.

On my first night as casualty officer, as green as the water meadows of Alt-na-Brocaidh after the farmers have thoughtfully dumped fertiliser upriver, a young man was brought in unconscious. In those days I was quite thorough (I’ve matured since), so—among other things (such as pressing knuckles on his sternum to check he wasn’t faking)—I ordered a drug screen.

I then received a call from the lab technician who explained politely that it was not lab policy to perform drug screens on unconscious patients without certain other indications. They had a protocol, she said. I can’t remember what these indications were, but in those days protocols were new-fangled and sounded quite impressive.

In those days, also, I was easily persuadable (I’ve matured since), which is usually a virtue and especially so in Northern Ireland, so I accepted this explanation. But when I described what had happened over coffee to the grey-as-a-rat medical registrar, who’d been working there for donkey’s years, he bristled with rage.

“I’m sick of those bastards,” he said, spitting at a passing porter, “What do lab techs know about patient care? That guy is your patient, you are the doctor, you are on the front line, you make the decisions; you are responsible, if something goes wrong it won’t be the lab tech who gets the blame. The buck stops with you, that’s what being a doctor is all about, and if you think you need a drug screen, damn well order it.” He stopped short of waving the Stars and Stripes and shouting, “You da man, you’re bad,” but it was pretty rousing stuff.

Once again easily persuaded (sometimes this is not such a virtue), I rang back the lab tech and damn well ordered the drug screen done stat with no arguments and no messing, right? I was the doctor, he was my patient etc.

A few minutes later, the casualty sister came in, a dignified procession of one, and, portentously discreet, whispered deafeningly and rather moistly in my ear that the professor of chemical pathology wanted to speak to me; at once, she emphasised.

“F***,” said the registrar, a small, chubby Pontius Pilate, making the traditional medical hand-washing gesture, “you’re in big trouble now.”

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