Just rolled by eyes....

[Mossjoh]

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So, I'm probably a budding internist. I'm currently in my 3rd year OB/GYN rotation. A patient came in today and said, "My toe nails are really thick and the bottoms of my foot is scaly" (Was there for other Ob/gyn complaints, but not important to the story.) The 4th year OB/GYN resident says "Go get some over the counter topical antifungal cream, see what that does." The internist in me is screaming, and I wanted to say, "umm, hey, thats not going to work..."

Another example, a non-pregnant hypertensive late thirty early old female with HTN, primary care doc is the attending OB/GYN. Nice guy, great teacher, but has her on methyldopa as the only drug for her HTN. I just don't get it. I did point out though to him that actually thiazides are usually first line followed by ACE-Inhibitors. I felt better when he decided it was probably better for her HTN to be managed by an internal medicine doc and referred.

Its amazing how these specialists learn their own field, and seem to forget other stuff. Anyone had this type of experience?

Mossjoh

 

[ekimsurfer]

You must know more than the real doctors... perhaps you can just skip the 4th year and Residency and go straight into practice?

The 4th year resident was probably sick of having his/her time wasted. And the doctor was probably just humoring you. Telling docs what to do is a good way to earn negative brownie points... but you are your own maker.

 

[Mirror Form]

You must know more than the real doctors... perhaps you can just skip the 4th year and Residency and go straight into practice?

If you've never once noticed an attending or resident make a mistake, then you must be pretty slow!

 

[Mossjoh]

Whatever....it was just something I noticed. And in no way did I challenge the attending, we just talked about it. He actually asked me what is usually used by the internists.

 

[Wednesday]

Its amazing how these specialists learn their own field, and seem to forget other stuff. Anyone had this type of experience?

Mossjoh

It goes both ways. When I was on Ob/Gyn, we were consulted to the MRICU for a 97 year old with "vaginal discharge". Let's just say, it turned out to be something yellowish the nurses noticed on the sheets (probably feces) told the internist who said "consult gyn" because he/she didn't want to look at anything "down there". We're all trained to do pelvics, right?

I wouldn't expect an Ob/Gyn to know the latest recommendations for HTN, but I would expect him to refer (which it sounds like he did). But you have to remember that even internists are specialized. And hey, not all physicians are the greatest physicians ever. That's why we're being exposed to so many, so we can take what works avoid what we think is bad, and incorporate all the good stuff into our own practices.

 

[ekimsurfer]

If you've never once noticed an attending or resident make a mistake, then you must be pretty slow!

like i said... you are your own maker.

if you want to go around letting the superious know how much more intelligent you are then they, go right ahead. but just remember that they've been playing the game longer than you, and don't be surprised if they come out with some special plays.

 

[electra]

Agreed...especially since ACE-Is are teratogenic and contraindicated in pregnancy.
It's nice to know a bunch of stuff, but to be honest, try not to know too much. It really can backfire on you, bu making you look unteachable. There's not much that's worse for the reputation of a student besides dishonest or unethical.

if you want to go around letting the superious know how much more intelligent you are then they, go right ahead. but just remember that they've been playing the game longer than you, and don't be surprised if they come out with some special plays.[/QUOTE]

 

[snowinter]

Mossjoh ( sp?)

yeah i feel the same way sometimes -that the internist in me is screaming out things; at least i did for a little while after i finished medicine rotation; then i started getting into the other fields that i was rotating through and now i don't hear that voice as loudly.. so i am VERY VERY CONFUSED if there is an internist living in me and what i wanna do. i hear it's normal;

i agree with everyone the best way to approach it is to ask "so why not this instead of that, instead of telling them something u learned somewhere else to be mroe correct -- but ASK..

take care and good luck with deciding what u wanna me!!!

 

[Resident Alien]

was she pregnant? methyl-dopa isnt a bad choice in that scenario......

 

[cheech10]

He says she wasn't pregnant as his first words to describe the patient. Why is an OB managing hypertension in a non-PIH scenario?

The point isn't the OB's lack of knowledge, but rather why specialists try to manage issues that they don't hve experience with.

 

[Doc Ivy]

Agreed...especially since ACE-Is are teratogenic and contraindicated in pregnancy.
It's nice to know a bunch of stuff, but to be honest, try not to know too much. It really can backfire on you, bu making you look unteachable. There's not much that's worse for the reputation of a student besides dishonest or unethical.

if you want to go around letting the superious know how much more intelligent you are then they, go right ahead. but just remember that they've been playing the game longer than you, and don't be surprised if they come out with some special plays.

Uh, the point was the patient wasn't pregnant!!!

Anyway, in Mossjoh's defense, I don't think he/she challenged the superiors... he/she merely noticed some deficiencies in their clinical judgement and is airing this on an ANONYMOUS MESSAGE BOARD! Frankly, this is the type of person I'd want on the team. Someone who is actually thinking about patient management and not just blindly follwing orders just because. Patients die when no one questions bad decisions. Bravo to the OP. 👍

 

[fourthyearmed]

I think the whole point the OP is missing is that once you pick a specialty you could care less about the things that other specialties normally handle. Surgeons consult medicine when they have a diabetic who needs surgery just because they're no longer comfortable with handling their sugars. Internists consult OB's for gyn problems. Ortho consults everyone. That's just the way it works and it's a good thing. You'll understand once you decide what you want to do. Now that I've decided to do peds everything regarding chest pain or vaginal discharge has gone from my head. On the other hand, my friends going into IM know nothing about things I think about every day like RSV. Is that good? No. But that's the way it goes. You just forget.

 

[tupac_don]

You must know more than the real doctors... perhaps you can just skip the 4th year and Residency and go straight into practice?

The 4th year resident was probably sick of having his/her time wasted. And the doctor was probably just humoring you. Telling docs what to do is a good way to earn negative brownie points... but you are your own maker.

Not neccessarily. I had an OB/GYN resident prescribe a cephalosporin, when a pt had an anapylactic rxn to cephalosporins and penicillin!

Two I had an OB/GYN tell me that he is only an OB/GYN and doesn't know much about ID, "let ID handle the infectious issues". So I wouldn't say that attending was necessarily just "humoring" the guy.

 

[Mossjoh]

Look, I'm sorry for posting this thread. I was making a simple observation how the different fields of medicine think differently. I meant no disrespect to anyone or to those I worked with on either case, they know much more about OB/GYN than I could ever hope to. I'm sorry someone took what I wrote as disrespectful and arrogant, it certainly was not meant to be.

I'd love to close this post and make it disappear

 

[gwyn779]

Look, I'm sorry for posting this thread. I was making a simple observation how the different fields of medicine think differently. I meant no disrespect to anyone or to those I worked with on either case, they know much more about OB/GYN than I could ever hope to. I'm sorry someone took what I wrote as disrespectful and arrogant, it certainly was not meant to be.

I'd love to close this post and make it disappear

It's actually a good point to make. Most of the specialists I've worked with know when they're out of their area and will refer or consult, but I've also seen some who were trying to manage problems they didn't know much about and weren't doing a very good job. Sure, as a student you're graded on attitude and medicine is still very heirarchical, but if you see something that's possibly harming a patient, it's more than reasonable to at least ask about it. Coming right out and saying "you're wrong, how could you be so stupid" is obviously the wrong thing to do. But asking as a person who's still learning is completely different.