Back in the Saddle Again

So I've been spending some time (quite a bit of time) back where I belong. Or at least, where I thought I belonged. Not in an academic centre, but in a community emergency room-- the same community where I have been practicing family medicine for three months. A surprisingly busy community emergency room.

My first shift was less than stellar, however. My preceptor had nicely written the emerg docs a letter of introduction. I would like to introduce my resident, blah, blah, very competent, blah, blah, good technical skills, suturing in particular, blah, blah, please be nice to her. And the morning that I was to start in the emerg, he was even nice enough to go over and remind the doctor on dury that I was coming by to work that day. Apparently, the emerg doc wasn't really listening.

When I got there he nodded curtly and gestured for me to follow him into the patient's room. So I did. And listened patiently while he assessed her. When we emerged, he started the inevitable pimping.

"How do you diagnose the patient?"

I HATE the 'guess what I'm thinking' game. What is he asking me? Does he want me to explain what I'm looking for? What tests I should order? What my differential diagnosis is? What I had for breakfast this morning?

"What do you mean?" I ask.

"Through the HISTORY and PHYSICAL, of course!!!"

Um, sure. I thought he was referring to some revolutionary test he had recently invented to decipher 'weak and dizzy old lady' into a concrete diagnosis and treatment plan. Apparently not. So then he proceded to sit me down and write out exactly what the components of a good history and physical were. I had been pretty quiet until now, but I decided to speak up.

"Sir? I *have* done this before." I said jokingly.

Apparently, the wrong thing to say. He looked up at me, clearly offended.

"I am TRYING to teach you something here. This is the sort of thing that will be on your EXAMS."

Alrighty then. So I sat, quietly and patiently, while he explained how to take a history and physical. Then, how to palpate an abdomen. Then he decided to teach me an approach to reading ECG's. He told me how to assess a headache. He asked me what the ABC's of trauma were. He also continued to pimp me, asking me random questions about appendicits, long Q-T syndrome and the administration of TPA in stroke. So I answered his questions. For six hours, I followed the attending around like a big dumb sheep.

Finally, just before shift change, he was assessing a woman with abdominal pain and asked me what was the first thing I needed to know. Easy one.

"I'd want to know whether or not she was pregnant."

"Right," he replied, "and why is that?"

"Because I'd need to rule out an ectopic."

He stopped. And eyed me suspiciously.

"Have you done much emerg yet?"

Confused by his question, I started to babble. "Well, not since I was a clerk. See, I started off in the FRCP program, but then I switched to family medicine, but I never actually DID any emerg shifts as a resident, but I..."

He cut me off. "You're a first year RESIDENT?" he asked, incredulously. "I thought you were a first year MEDICAL STUDENT."

Um, thanks. You don't think it's odd that I know about long Q-T syndrome as a first year medical student, but knowing about freaking ectopic pregnancy tips you off? Not to mention the nametag I'm wearing that clearly identifies me as DR. Couz, Medical Resident? Or the fact that my preceptor introduced me to you TWICE??? Apparently, I am clearly the world's brightest and most knowledgeable first year medical student.

Somehow, this misunderstanding was my fault.

"If I had KNOWN you were a resident... well, you should have been writing ORDERS! You should be formulating TREATMENT PLANS!"

No kidding. Sigh.

Thankfully, I don't think I'm working with this bonehead again.