In general, I agree with your critique. Just a couple of things: in MY day ('91-92 internship year) we signed out by WRITING notes on a dot-matrix printed patient list, then verbally signed out to the NF team. (This was back in the good old, pre-HIPPA days.) The NF team always had the beeper numbers of the regular team, but it was considered Bad Form to call for all but the most horrific problems (no, codes and/or death weren't considered bad enough to warrant a call)--I suppose this was a macho attitude kind of thing. One more thing: Delirium is ALWAYS bad (remember the mnemonic 'I WATCH DEATH' for the differential), and if you're handed a delirium of unknown etiology you should (a) chew out the slug who's handing it to you and (b) start working it up yourself, if the slug won't. In Dr. Jahuar's article it sounds like the workup was already started (else, why the CT scan?), in which case, the 'just snow 'em with Haldol and Ativan' might be the best possible course, and thus the appropriate sign out. True, delirium itself won't kill you...but the things that CAUSE delirium often WILL! The brain is the most sensitive organ to the body's condition, and when the sensorium goes screwy, it's usually a sign that the rest of the body is about to go kerplunk-kerplooey.

Yes, those are technical terms we old Attendings use. Not all of us old guys are senile incompetents...yet. Some of the 'old ways' we old farts learned can sometimes come in useful...I'm reminded of having to examine a patient with pneumonia during a power outage at a small rural hospital without a working generator. My good old stethoscope and a bit of chest percussion made the diagnosis just as accurately as a thoracic spiral CT...and I didn't need a medical database to start empiric antibiotic therapy. I wonder sometimes just how docs yet to come will cope with such onerous situations?

Remember: The art of medicine consists in amusing the patient while nature cures the disease. ~Voltaire