New attending syndrome. It’s the well-known phenomonen of attendings fresh out of residency being a little hesitant to diagnose anything during the month of July.
Mostly you can work around it, but when a radiologist comes down with it, things start going haywire.
There’s a new radiologist on staff, and I keep running into her and her readings. So far they’ve been exemplars of non-specificity, but today was the worst. I got called about a patient in the ER, a boy with abdominal pain. “The radiologist says he could have perforated diverticulitis, please come and see.” Now a teenager shouldn’t have diverticulosis, let alone diverticulitis, let alone perforated. So I looked at the scan, and I couldn’t really make out what the radiologist was worried about, but hey, I’ve been not-an-intern for two weeks, and this is an attending radiologist, so I’d better be careful. I went and saw the patient. He was sore, but not too bad. In fact, he and his father seemed more scared by what the ER doctors had told them about the CT reading than about his actual symptoms.
I looked at the scan and I looked at the scan, and all I got was more puzzled. Finally I went and told my attending that the patient was tender, but not too extremely so, but I was concerned because we had an official dictated and signed report saying possible perforated diverticulitis vs. small bowel obstruction due to Meckel’s diverticulum. He listened to me arguing back and forth with myself, and came to see the patient. He spent a long time calming them down, but when we finally got outside of the room he wasn’t exactly pleased. “That radiologist! What is she reading it like that for? A third-year medical student could tell there’s no diverticulitis. In fact, there’s no inflammation of any kind whatsoever!”
So now I feel like an idiot. I knew the patient wasn’t sick, and I knew there was nothing wrong with the scan, but I let the radiologist talk me into miscalling it, and presenting it to the attending as something concerning. I’ve learned not to trust the radiology residents too far, and now I’m afraid I have to learn not to trust the radiologists much at all (except for three, who are nearly infallible, and all the attending surgeons take their word as gospel). Which scares me more than anything, because I don’t think I’m good at reading CT scans, and clearly I need to be a lot better.