Stick to What You Know

Dear, primary care physicians, I admire your commitment- really I do.  BUT. Perhaps acute, inpatient management is not an appropriate application of your knowledge and skills. Case in point: 100 mcg Fentanyl IV push is not an appropriate dose for a LOL whose extent of opioid tolerance is the occasional Vicodin tab.

Separate case in point: Just because thus far the vital signs are stable, doesn't mean that a patient with abrupt delirium (periods of lethargy interrupted by confused yelling out, and overall twitchiness) is "stable". Just because the head CT and MRI were negative, and you have no clue as to the cause of this altered state doesn't mean this patient is "stable" and therefore should not be transferred out of med/surg to a higher level of care.