I'd like your opinion on something

[spootbat]

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I am on a rotation right now, and I am pretty handy with the ophthalmoscope. Today we were rounding with the attending and a resident, and the attending was looking at a patient's eyes with the ophthalmoscope as part of an exam. After trying, the attending said that he/she couldn't visualize the fundus, and that we should call an ophtho consult. After rounding, I used my scope to look at the patient, and I managed to see the disk pretty clearly with some pathology actually present.

I went back to my resident and told her what I found, and it sounded like he/she was impressed that I was able to do that. But now I am worried that it will make its way up the ranks back to the attending that I checked the patient again, and that he/she will be pissed that I was double-checking him/her or making him/her look bad.

What do you think?

 

[thepoopologist]

What's done is done. If the attending acts negatively then he's an *******

 

[werd]

well nice work, assuming said ophtho consultants agree with you.

i think you'd only run into a problem if you went to the attending and were like "i took a look with my ophthalmoscope after you left and..."

 

[officedepot]

if the attending is cool then he/she will actually be glad to hear to took the initiative. I think you should report what you found and see what ophtho says but do it before they write their note so it can make you look smart.

 

[Valadi]

You're fine. You'd have to have an incredibly rare attending who would knock you for practicing something and succeeding. If you're not confident about what you saw, I wouldn't put it in a note that may change plan of care or confuse people (depends on your hospital), but I would casually mention it on rounds in morning (hopefully before ophtho sees the pt) with the modifer , "So I'm curious to see if this will be consistent with Ophtho."

 

[Mr hawkings]

You're fine. You'd have to have an incredibly rare attending who would knock you for practicing something and succeeding. If you're not confident about what you saw, I wouldn't put it in a note that may change plan of care or confuse people (depends on your hospital), but I would casually mention it on rounds in morning (hopefully before ophtho sees the pt) with the modifer , "So I'm curious to see if this will be consistent with Ophtho."

Plus i think the attending would be impressed by the fact that you are comfortable with a funduscopic exam at this point. Many of us will not be able to do one properly till deep into residency if at all

 

[Rendar5]

I'm going to have to disagree with the above posters, having seen lots of different attendings with lots of different personalities. You could have a great one who'd be impressed and suggest you go into ophtho, or you could have one with an ego that may get defensive if you tell him the wrong way. The resident was the appropriate person to tell. In fact, he may know the attending well and know how to properly pass along your exam in a way that makes you look good without making him defensive.

 

[vicinihil]

share every small success to be recognized! That leads to great evals. Even if residents recognize you rock, they will pass word on up and will be reflected in your eval.