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- Sep 25, 2010
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Hi everyone,
I haven't actually posted in a while and not much when I did, but I'm now an incoming MS4 and I'm heavily leaning towards EM. I'd say decided but I'm only a week into my sub-I and that seems a bit presumptive. Anyway, I'm trying to get better and to that end I watched this video how to think like an emergency physician () that some people recommended and based on that, other discussions on here (lurking) and what I've seen I'm a bit...confused.
What's the point of the history in EM? I mean, I get how getting a history can lead you down one path more quickly (typical MI history and you get an EKG immediately if they didn't already have it, etc.) or make you front-load things in a certain way (again, if you're suspecting MI from the history you more quickly go down that path than sending them to CT for PE) but it seems like that's all it's used for. It seems like you get the CC and then your work-up is pre-defined for you, and the only real point to the history is to identify *maybe* in what order you do things and as an adjunct to help you rule in/out (that is to say there are key specific questions that are yes/no that can help you in the same way a lab test would help you). Seems being the key word - I'm essentially asking what I'm missing.
For example, I saw this 50 yo M with chest pain the other day. He had a + family history, but was otherwise super crazy healthy (triathlete) with no risk factors. But I feel like my presentation could have just been "50 yo M chest pain since this am +family history" and stopped right there because any other details don't matter: he's bound for the same work-up essentially just based on the CC. And sure, I absolutely get the MI workup, but we also got a d-dimer. I can't really figure out how necessary that was.
Reading back I'm not sure if I'm actually articulating my problem super well. It just feels like at triage they could hear the CC, and put in an order set from a dropdown menu based solely on that. Our job would then be to do the specific history and physical questions/maneuvers appropriate to that CC (chest pain needs Q about history of travel, and auscultating the heart), combine that with the results, and work from there. It feels like there's no discretion.
Still feel like I"m articulating this poorly. I'll post it in case anybody gets what I'm saying.
I haven't actually posted in a while and not much when I did, but I'm now an incoming MS4 and I'm heavily leaning towards EM. I'd say decided but I'm only a week into my sub-I and that seems a bit presumptive. Anyway, I'm trying to get better and to that end I watched this video how to think like an emergency physician () that some people recommended and based on that, other discussions on here (lurking) and what I've seen I'm a bit...confused.
What's the point of the history in EM? I mean, I get how getting a history can lead you down one path more quickly (typical MI history and you get an EKG immediately if they didn't already have it, etc.) or make you front-load things in a certain way (again, if you're suspecting MI from the history you more quickly go down that path than sending them to CT for PE) but it seems like that's all it's used for. It seems like you get the CC and then your work-up is pre-defined for you, and the only real point to the history is to identify *maybe* in what order you do things and as an adjunct to help you rule in/out (that is to say there are key specific questions that are yes/no that can help you in the same way a lab test would help you). Seems being the key word - I'm essentially asking what I'm missing.
For example, I saw this 50 yo M with chest pain the other day. He had a + family history, but was otherwise super crazy healthy (triathlete) with no risk factors. But I feel like my presentation could have just been "50 yo M chest pain since this am +family history" and stopped right there because any other details don't matter: he's bound for the same work-up essentially just based on the CC. And sure, I absolutely get the MI workup, but we also got a d-dimer. I can't really figure out how necessary that was.
Reading back I'm not sure if I'm actually articulating my problem super well. It just feels like at triage they could hear the CC, and put in an order set from a dropdown menu based solely on that. Our job would then be to do the specific history and physical questions/maneuvers appropriate to that CC (chest pain needs Q about history of travel, and auscultating the heart), combine that with the results, and work from there. It feels like there's no discretion.
Still feel like I"m articulating this poorly. I'll post it in case anybody gets what I'm saying.