It’s starting to dawn upon me that all the chiefs and attendings I’ve found very annoying or stressful have actually been teaching me a great deal. Most of them, because it was their personal demand for excellence and thoroughness which was irritating me; a very few, because their laziness was forcing me to take more responsibility for being the thorough member of the team.
Too bad that it usually takes me six months after a rotation to realize what any particular chief or attending taught me.
But I recognize now that my regard for getting some degree of social history; my attention to looking at all the available imaging; my goal of knowing absolutely all the details of the medical history before calling the chief or attending; my thinking about electrolytes in the ICU; my thinking about DVT prevention – they all came from chiefs and attendings whom I found nearly intolerable at the time – because I wasn’t yet prepared to think that hard or that thoroughly about “only” a surgical patient.
Now if I can just think of that when I’m getting annoyed at someone. . . what is it that they’re teaching me?
I remark on the above, in order to avoid relating in detail how extremely annoyed I am at an ER resident and attending, who called us ten minutes before signout with a claim of appendicitis, on a college-aged female, without obtaining a white count, a pelvic exam, or a CT scan. I’ll grant that the CT scan is probably unnecessary. But they seriously seemed to expect us to book the patient for the OR without knowing any lab values, and without anyone having done a pelvic exam. (She had pain, but no peritonitis.) Please tell me if I’m mistaken, so I can stop being annoyed at them; but in the real world do ER physicians call surgical consultants without either a CT or a pelvic, on a young, sexually active female patient?
(I’m sure they’re teaching me how to be polite to frustrating referring physicians. . . like the PCPs whose first test for gallbladder disease is the HIDA scan. . . I haven’t quite learned it yet.)
Cut On The Dotted Line 
December 21, 2009 at 9:30 pm
Yes, in the real world that happens. It shouldn’t. But in the real world, time is limited, one person can only assess one patient at a time, tests can’t be obtained without the passage of time, and alot of ER docs have decided they don’t need to do pelvics.
December 22, 2009 at 2:45 am
Please tell me this person had at least done a pregnancy test!
December 22, 2009 at 6:03 pm
ooops – I just finished complaining about just such a teachable moment that occurred this afternoon….
December 28, 2009 at 11:04 am
[…] about learning lessons, Dr Alice rants about a recent referral to the surgical team about a young college-aged sexually active female with ?appendicitis but has […]
January 6, 2010 at 1:54 am
I don’t know if you use any of the scoring systems for appendicitis, but I’ve been using the Alvarado score (it’s in Schwartz). This requires either a WCC or a CT to make a diagnosis of appendicitis.
Today in clinic I saw two patients who went to an open appendicectomy without imaging; one got a Hartmann’s for diverticulitis (rightsided redundant sigmoid) and the other an oophorectomy for torsion.
Mind you, they do call without any test results, and Cope’s says that you should make the diagnosis clinically. I mostly tell them that I will come when I can, but I won’t take the patient off their hands until I’m satisfied.