The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Tuesday, April 04, 2006

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.

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Anonymous Anonymous said...

i know how you feel. it drives me nuts when people assume i'm the flight attendant, not the pilot. the incredulous looks are getting a little old!


9:45 AM

Anonymous Anonymous said...

ROTFL!!! That's the funniest thing I've heard in a while. How you managed to keep your cool is incredible. I would have felt like decking the a@*hole! I'd love to find out where you're placed -- send me an email sometime! We should hook up!

9:58 AM

Blogger dinah34 said...

couz, i always look forward to reading your blog. you have such a way with words.

i don't know how you didn't strangle that man and leave him for dead.

11:08 AM

Blogger Nikki said...

I can never figure out how so many morons (like your preceptor, for example) actually manage to get through med school and residency.

I mean, I'd like to think that I have a little intelligence (or at the very least, some common sense), and I'm not exactly BORED these days. You would think that someone as cluelss as your preceptor would never actually survive!

And yet, we all know that there are many many doctors out there who are living evidence to the contrary.

I hope the rest of your rotation is a bit more fun. :)

3:36 PM

Blogger Leah said...

I'm not sure why I keep asking you all my medical questions if you don't even know how to do a proper history and physical. Hmm. ;)

1:16 PM

Blogger Fat Doctor said...

Two things:

First, I'm linking to you on my site. Please let me know if that causes you any discomfort or lost sleep or whatever.

Next, you're tagged (4x4). Now do it!


2:09 PM

Anonymous mchebert said...

Says a lot about your preceptor that he was not embarrassed at making such a stupid mistake. I know I would have been.

Many doctors make snap judgments about people (I guess it has to do with the speed and frequency with which they have to make decisions). They tend to size you up in seconds, and then you can't reverse that impression, even if it is wrong, no matter what you do.

Well, at least you took six hours to decide that he was a fool.

3:26 PM

Blogger The MSILF said...

This is a GREAT story! Love it!

4:14 AM

Blogger M. Dyspnea said...

That story made me really happy. I don't think I'd have the discipline to let someone hang themselves like that. Kudos.

2:17 PM


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