To new MSIII's.... from your intern

[MediCane2006]

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\ point is if you're a dick, i'd rather not have to waste my time if we're not going to be friends and you're not going to help me out in any way.

A friendly reminder to MS-3's, coming from personal experience - this goes both ways. If you're a cool person to work with, you're going to make it easy for not just your intern, but for your entire team to exert themselves to make the rotation a valuable experience for you. If you're unpleasant, it's awfully tempting for the other team members to ignore you and just work around you.

i

I've definitely worked the hardest on the rotations where i was part of the team and felt appreciated and was actively learning.

I couldn't agree more. Carry yourself like an important part of the team, not just "the token med student", and you may work a little harder, but you will learn exponentially more.

 

[Mayhem]

Its just the tone that rubs many people the wrong way--although perhaps not you. When people are confronted with this tone, they can't hear the important and useful message behind it. Given a choice of how to present the information, the OP has chosen to offer it in a package that is difficult for many to deal with.

This may or may not make him an a**hole--we are all responsible for our own reactions to things-- but it does make him a less effective teacher. And, whether he likes it or not, the system he is training in requires him to play the teacher role.

As an MS, I would prefer to have more effective teachers than less effective ones. I think most people would feel the same way.

I didn't hear the tone when I was reading. Maybe I'll read it again. I feel weird for being the odd one out. There's this kind of weird peer pressure that makes me think I should scream "You insensitive jerk, I hope you burn in hell!!!" Hmm...maybe later.

I would advise everyone to read his post though. The tone might be antagonistic but he's not lying.

 

[beary]

It's the med students who were the a$$holes at my institution. Thus the advice.

I'll assume that you are including yourself in this.

 

[Red Beard]

I didn't hear the tone when I was reading. Maybe I'll read it again. I feel weird for being the odd one out. There's this kind of weird peer pressure that makes me think I should scream "You insensitive jerk, I hope you burn in hell!!!" Hmm...maybe later.

Cool, I hope to be more like that down the road. At this point, my skin is still pretty thin!

 

[Igor]

Well this intern won't last long unless he changes his attitude. I hope he didn't match to my program.

MS3s - just care about your patients. If you just can't do that, then:
*be obsessive about the details
*make a game out of having the right answer
*accept the fact that your grade will be whatever is average in your school.

Interns:
If you can't explain to an MS3 why you're doing it now (when you are tired, hungry, and stressed) in 25 words or less, then you won't be able to explain it to your attending post-call. (And we will ask). If you're not sure what to do you have 2 choices:

*If the pt is stable, do nothing and call someone you trust for help
*if the pt is unstable, call a code

Can't we try to have some fun on wards? Threads like this make it look like the ward teams argue a lot. Mine don't.

Igor

Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.


1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.


I'm sure there's more, but that's what's off the top of my head right now. Any questions? Additions from other current or near-future interns?

 

[Sammich81]

being the first to answer some question about the patient does not make you look better. what is impressive is if you go the extra mile for things that are RELEVANT, or demonstrate good fund of knowledge. not this "i talk first" stuff.
.

Oh oh those "I said it first" MSIII's were the worst to rotate with! I hated, hated, hated it when a question was clearly not directed at them and they jumped in. Most recently this was the same guy who fake-jokingly accused me of being at a party when I had been sick (sick enough that my hardass attending sent me home during pre-rounds)...I was literally in the middle of saying tricuspid regurg, and as I said tricuspid, he jumped in!

Also someone said, "Since when do attendings and residents stand around while the intern pimps someone who knows as much as they do?" Nice interns don't pimp on rounds. But I had one who would pimp on work rounds, on attending rounds, and in the OR...we hated him. What a jerk. We put a sign that said, "I am a penis" on his back one day, which almost made up for it.

Final caveat- I had a great time on the majority of my rotations. The team got along great, we had a good time, I posed a "Sorry I farted" sign on my interns back (but not out of revenge, just because it was the last day and all the residents were kind of punchy. He laughed about it.)

 

[velo]

why do I get the feeling that this OP is going to wind up with more than a few signs on his back?

 

[BlazerMed]

why do I get the feeling that this OP is going to wind up with more than a few signs on his back?

I'd be willing to bet you could say that about of a few other people that have posted on this thread.

 

[NY Musicologist]

I didn't hear the tone when I was reading. Maybe I'll read it again. I feel weird for being the odd one out. There's this kind of weird peer pressure that makes me think I should scream "You insensitive jerk, I hope you burn in hell!!!" Hmm...maybe later.

I would advise everyone to read his post though. The tone might be antagonistic but he's not lying.

I'm with you, Mayhem--when I first read the post, I thought most of the advice sounded, well, sound, and I was taken aback by the negative replies. When I took a second look, I did see how some of the phrases could be taken as objectionable...although I'm still not offended!

 

[bigfrank]

Hi soon-to be MSIII's. I'm your intern, or at least I will be as of next month. I thought I might take this opportunity to tell you a few things about how this next year is going to work. These little gems are in no particular order.


1) I'm not your friend. I want that to be clear. I assume you have friends already. We're coworkers, colleagues, mentors/proteges, whatever. But not friends.

2) We should be friendly however. If I'm not civil, it may be because I am tired. It also may be because you are stupid, lazy, or a d!ckhead. I'll try not to be tired. What are you gonna do?

3) Don't adopt the attitude that you are paying tuition therefore you call the shots. I am "paying" in the form of opportunity cost by accepting this pittance of a salary, and I already paid my tuition, so spare me the drama. We are both in the midst of necessary training, so salary vs. tuition is just a technicality. Accept your role, play it well.

4) My first priority is patient care. PATIENT......CARE...... not teaching, not sleep or eating, not letting you do procedures. AFTER the patients come all of these other interests.

5) At worst, be on time. Ideally, be five minutes early, and don't act annoyed that eveyone else is five minutes late. Don't EVER be late yourself.

6) You will get what you deserve, good or bad. If you aren't getting what you deserve, I will try to intervene to make it so (see #8,9). Good OR bad. I'm no cheerleader, and no saboteur, but I will expend energy for the sake of fairness.

7) I should teach you stuff. And I will. But don't ask me a hundred questions during rounds. And if you do anything that remotely sounds like YOU are pimping ME, you will regret it forever. I promise.

8) Don't lie. Don't be a dick. Don't feud with anyone. The residents and attendings will discuss you behind your back, and their allegiance is to each other more than to you. Yes, even the a$$hole residents/attendings, because we have to work with each other longer than we have to work with you.

9) Work hard, be enthusiatic, volunteer to do things that make my life easier. I will care more about this than about the text book or journal you read last night. And if/when I'm happy, I'll create opportunities for you to show off what you've been reading about, opportunities to look like a star.

10) If I give you advice about how the chief or attending likes presentations, or how you should be writing your progress notes, just trust me and try it that way. If I haven't worked with them long enough to know their preferences, I wouldn't be telling you. And if I have, then you should listen. Bad presentations and crappy progress notes make everyones' lives more painful, and that pain will trickle down onto you.

11) We will notice if you look out for your fellow students, and if you don't. We like it when you do. I want my co-residents to have my back, and I want to protect theirs. If you aren't doing this now, how can I expect that you will be doing it a couple years from now?

12) Don't lie, it bears repeating. If you don't know a lab or vital or the PCA data, it's okay, don't make it up. If you want a day off, say so. Don't claim illness or the like. I will do whatever is reasonable to help you get what you want out of this clerkship, but I will BURY YOU if you lie to me about ANYTHING, no matter how inconsequential it seems to you.


I'm sure there's more, but that's what's off the top of my head right now. Any questions? Additions from other current or near-future interns?

You are an ass. I am sorry you didn't get the match you wanted. Your medical students will hate you, which is probably what you want anyways.

Quit overcompensating; you must be nervous about starting residency. And you certainly should be.

🙂

 

[bigfrank]

P.S. You, as an intern, will be an annoyance to your upper-level resident "coworkers."

 

[NY Musicologist]

Wouldn't you want to formulate a strong friendship between the intern and students? I would think it would make for a more cooperative and better learning environment.

This "friendship" issue seems to have hit many people's buttons. It seems to me that the problem lies with differing perceptions of what constitutes "friendship." As the OP made clear (at least to me) in point #2, it is possible to be "friendly" with someone and still not consider them a "friend."

Quick example: I have a part-time job. I like, respect, and enjoy the company of, most of the people I work with. I care about them as people, but they're not "friends"--we get together for the occasional after-work drink, or to celebrate major life events (weddings, babies, etc.), but I don't share the details of my private life with them, nor do I want/expect them to share theirs with me. Thus, when we're at work, we focus on...WORK...with the occasional water-cooler chitchat about weekend plans, etc. Recently, a genuine "friend" of mine--someone with whom I DO share secrets, etc.--joined the staff in my department, and it has been a problem for our productivity: since we both know and care about many, many things going on in each other's lives, there's just that much more opportunity to get sidetracked from the task at hand, even though we're both conscientious people and generally capable of disciplining ourselves to get done what we need to get done.

So, in a rather large nutshell, I'm with the OP: be friendly with your interns, residents, etc., but don't be "friends" to the point where your friendship has even the potential to interfere with your responsibilities. (Furthermore, for the MSIII/intern relationship, what's the point of forming a "friendship" for a six-week clerkship??)

 

[rotatores]

I also have to agree with most of what the OP wrote...granted he/she could have phrased it differently...but come on people...if you are getting all pissy now from a little advice on SDN....what's gonna happen next yr when your resident or attending gets in your face. I sincerely hope you don't snap back with smart a$$ replies like the ones on this thread.

rotatores

 

[velo]

I also have to agree with most of what the OP wrote...granted he/she could have phrased it differently...but come on people...if you are getting all pissy now from a little advice on SDN....what's gonna happen next yr when your resident or attending gets in your face. I sincerely hope you don't snap back with smart a$$ replies like the ones on this thread.

rotatores

people will smile, nod, and take it. The anonymity of an internet message board just allows us to express what we'll be thinking as we smile, nod, and take it.

 

[rotatores]

people will smile, nod, and take it. The anonymity of an internet message board just allows us to express what we'll be thinking as we smile, nod, and take it.

Great point!!

 

[Khenon]

Quick question!!

Are there alot of liers during rotations? I noticed this emphasized numerous times. I guess I was kind of surprised. Sure there are liers out there, but the way this thread looks, you actually HAVE to tell people not to lie. I never really considered lying, but is something about my rotations going to make me want to lie? I just thought this was an odd consistency amongst all the advice flying around in here.

 

[bigfrank]

Quick question!!

Are there alot of liers during rotations? I noticed this emphasized numerous times. I guess I was kind of surprised. Sure there are liers out there, but the way this thread looks, you actually HAVE to tell people not to lie. I never really considered lying, but is something about my rotations going to make me want to lie? I just thought this was an odd consistency amongst all the advice flying around in here.

No. The OP is an idiot. Usually, things run fairly smoothly on the wards and I think medical students are generally honest people.

 

[MirrorTodd]

I didn't hear the tone when I was reading. Maybe I'll read it again. I feel weird for being the odd one out. There's this kind of weird peer pressure that makes me think I should scream "You insensitive jerk, I hope you burn in hell!!!" Hmm...maybe later.

I would advise everyone to read his post though. The tone might be antagonistic but he's not lying.

I didn't get the abrasive tones either, so you're not the only one. I think the problem lies with the way the post is addressed i.e. you/your. That seems to make it too personal. As if the OP is addressing the reader as an individual human being and not all the readers in general. Perhaps this person could have worded it so that "one is used in place of all the you's? i.e. "One will get what they deserve, good or bad."

 

[TBforme]

No. The OP is an idiot. Usually, things run fairly smoothly on the wards and I think medical students are generally honest people.

i agree. sorry deleted my story

 

[MediCane2006]

Quick question!!

Are there alot of liers during rotations? I noticed this emphasized numerous times. I guess I was kind of surprised. Sure there are liers out there, but the way this thread looks, you actually HAVE to tell people not to lie. I never really considered lying, but is something about my rotations going to make me want to lie? I just thought this was an odd consistency amongst all the advice flying around in here.

Liars?....no. I'd agree that most students consider themselves honest. But there are times when your intern asks you, "did you listen to her lungs?" or "any relevant family history?" or "no blood in the urine, right?" - i.e., something seemingly trivial that you forgot to do. If it's late, you're tired, etc. it can sometimes be tempting to fudge a bit. Writing RRR, no M/R/G when you didn't listen to the heart. Saying "labs are okay" on a very stable patient when you didn't check each and every value. The law of the hospital is, you are eventually going to get burned very, very badly if you get into this habit. Case in point - a friend of mine who was on his urology sub-I with the program director, reported a patient's urine as "clear" on rounds, and of course when the team went in the Foley bag was full of blood.

You're a med student - no one expects you to function at the level of a resident yet. So if you forgot something, say "I'm sorry, I didn't look/listen/ask/whatever". If you contaminate something in the OR, quietly alert the circulator. If you're not sure about a physical exam finding, ask for corroboration.

I think this is what the previous posters were getting at about "honesty".

 

[rotatores]

No. The OP is an idiot. Usually, things run fairly smoothly on the wards and I think medical students are generally honest people.

Bigfrank...why such the hatred?...am I missing something here? You have to admit...he's got some good points/advice!

rotatores

 

[bigfrank]

Bigfrank...why such the hatred?...am I missing something here? You have to admit...he's got some good points/advice!

rotatores

Please re-read the OP's entire diatribe and see why everyone else on here thinks s/he's an idiot -- I am inclined to think this is a female posting.

 

[footcramp]

lol why is anyone who you dislike accused of being a woman?

 

[MediCane2006]

Well, I'd be hesitant to call anyone an idiot based on a single post, especially when nuances like tone can be so easily misinterpreted. And quite honestly, while I guess I can see how some may have been offended by the perceived tone of Telemachus' post, I agree with those who have said that the essentials contained therein are very good advice points for MS-3's starting out in the less touchy-feely rotations, like surgery, medicine, obgyn etc. where things move fast and often fools are not suffered gladly.

Of course, I'm a female surgical intern-to-be. So take the above as you will 😉

 

[Zorlio]

...

I'm not in med school right now, so I can't comment specifically (please spare the "you shouldn't talk" comment because I'm purely commenting on the psychology behind what you said), but I just wanna say that you will make students hate being doctors. You'll come off as bitter, unapproachable, and full of disdain towards anyone but yourself or those above you, making those below you feel either (1) not good enough and doubt themselves or (2) bitter like yourself (ofcourse there is also (3) who will figure out that you're an a-hole to work with and do things not exactly to your pleasing, and that'll just make you even more of an a-hole to work with)

I had a high school teacher like you; he made me HATE bio and everything about it (good thing that changed due to other more human people). Any time you ask anything, you get back a "what, are you that dumb that you have to ask me that" type of stare.

You don't have to be an a-hole to get your point across, and everything that you said can be said without a threataning attitude and still have the same impact. Not being late, not being a dick (ironic), and caring about patients are all valid points, but you make the consequences of NOT following rules more imporant than the rules themselves.

 

[Sammich81]

Please re-read the OP's entire diatribe and see why everyone else on here thinks s/he's an idiot -- I am inclined to think this is a female posting.

Dare I even ask why? It sounded extremely male to me.

 

[Zuwie]

From what's been posted here, it may appear that lying is the worst thing you can do as a physician. There are many other things that are far worse than lying including prescribing a dose 10 times indicated, operating while intoxicated, operating 12 hours post-call, which is technically being intoxicated, tell your depressed patient to "stop whining" even if you are a surgeon, cracking someone's head open because they lied to you, well, you got the picture.

Also, some wrote you should not write RRR, no m/r/g when you haven't listened to the heart. Well, examining the heart involves using both the bell and the diaphragm, checking the JVD and the hepatojugular, palpating for thrills and making sure it's all on skin. How many surgery residents you know have done all this? So technically, according to a cardiologist, they haven't really "listened" to the heart. Plus, if there was no previous clinical suspicion of a heart disease based on history, auscultating the heart has no real value, so the "lie" has no repercussion to the patient whatsoever. It's just by mere convention that hearing one or two lub-dubs over gown means that you haven't "lied" about the rate and rhythm being regular.

My point is, you cannot be completely incapable of lying. Even smiling and nodding when thinking "what an a-hole" is technically a lie.

Robert Mugabe, the current leader of Zimbabwe, ran on the slogan "Vote for me or I'll kill you and your family." He got 99.9% of the vote because the people knew he was a very honest guy.

 

[bigfrank]

Robert Mugabe, the current leader of Zimbabwe, ran on the slogan "Vote for me or I'll kill you and your family." He got 99.9% of the vote because the people knew he was a very honest guy.

Really? This is interesting. I had no idea on this Mugabe guy. Sounds like a politican born for the U.S. system!!!

 

[Sammich81]

Robert Mugabe, the current leader of Zimbabwe, ran on the slogan "Vote for me or I'll kill you and your family." He got 99.9% of the vote because the people knew he was a very honest guy.

Or...maybe because they didn't want them or their family to be killed?

 

[velo]

Also, this has been bugging me but I'm not sure about it. Let me know if I'm A) wrong or B) just too picky, but aren't you unable to say its a normal rhythm just by listening to the heart? I thought I remembered "rhythm" refering to normal electrical activity (P followed by QRS followed by T), so technically if you just ascultated you can only say no M/R/G and regular rate. Wouldn't you have to check telemetry to say normal rhythm? I haven't started clinical years yet so maybe I'm option A or B above...

 

[velo]

Or...maybe because they didn't want them or their family to be killed?

Yeah, that's what he's saying. Being honest doesn't mean you're good, if it means you're very honest about being a monster.

 

[Sammich81]

Yeah, that's what he's saying. Being honest doesn't mean you're good, if it means you're very honest about being a monster.

Oh, I see, I thought he was saying that perfect honesty makes people happy even if it sucks. Riiiight.

As for "normal" rhythm...technically no you can't say that someone is in sinus rhythm by listening. When you write RRR people assume it's sinus, but I think what it most often conveys with "regular" is that it's not obviously irregularly irregular (ie a fib).

 

[Zuwie]

Really? This is interesting. I had no idea on this Mugabe guy. Sounds like a politican born for the U.S. system!!!

I recall this from George Carlin:

George Bush (the elder) said "I am an honest man" and the American people thought "Bulls&%t!" Bill Clinton said "I'm full of s&%t and how do you like that!" and the American people thought "Well, at least he's honest!"

 

[bigfrank]

I recall this from George Carlin:

George Bush (the elder) said "I am an honest man" and the American people thought "Bulls&%t!" Bill Clinton said "I'm full of s&%t and how do you like that!" and the American people thought "Well, at least he's honest!"

 

[Mayhem]

I had a high school teacher like you; he made me HATE bio and everything about it (good thing that changed due to other more human people). Any time you ask anything, you get back a "what, are you that dumb that you have to ask me that" type of stare.

Not to hijack the thread -- and please please please please please don't be offended -- but aren't we responsible for our own feelings? I understand that people's behaviour can affect how we see them and what they do (there's this really nice Psychiatrist who's making me actively consider it as a specialty). But isn't hate a little strong? Nobody should make you hate anything. I've had awful teachers all my life, most of them in med school, and if I was waiting on them to make me like half the stuff they've taught...well I don't really have to finish that sentence do I?

 

[bigfrank]

Not to hijack the thread -- and please please please please please don't be offended -- but aren't we responsible for our own feelings? I understand that people's behaviour can affect how we see them and what they do (there's this really nice Psychiatrist who's making me actively consider it as a specialty). But isn't hate a little strong? Nobody should make you hate anything. I've had awful teachers all my life, most of them in med school, and if I was waiting on them to make me like half the stuff they've taught...well I don't really have to finish that sentence do I?

Other people can influence your perceptions of a field of medicine or a school of thought. That is human nature: there is always some degree of transference; one cannot live in a vacuum.

 

[rotatores]

When you write RRR people assume it's sinus, but I think what it most often conveys with "regular" is that it's not obviously irregularly irregular (ie a fib).

As long as you write in the PE section of your note then nobody assumes "RRR" means normal "sinus" rhythm...RRR=regular rate and rhythm. If you were to write ECG: RRR, then yes....people would assume regular sinus.

rotatores

 

[footcramp]

From what's been posted here, it may appear that lying is the worst thing you can do as a physician. There are many other things that are far worse than lying including prescribing a dose 10 times indicated, operating while intoxicated, operating 12 hours post-call, which is technically being intoxicated, tell your depressed patient to "stop whining" even if you are a surgeon, cracking someone's head open because they lied to you, well, you got the picture.

Also, some wrote you should not write RRR, no m/r/g when you haven't listened to the heart. Well, examining the heart involves using both the bell and the diaphragm, checking the JVD and the hepatojugular, palpating for thrills and making sure it's all on skin. How many surgery residents you know have done all this? So technically, according to a cardiologist, they haven't really "listened" to the heart. Plus, if there was no previous clinical suspicion of a heart disease based on history, auscultating the heart has no real value, so the "lie" has no repercussion to the patient whatsoever. It's just by mere convention that hearing one or two lub-dubs over gown means that you haven't "lied" about the rate and rhythm being regular.

My point is, you cannot be completely incapable of lying. Even smiling and nodding when thinking "what an a-hole" is technically a lie.

Robert Mugabe, the current leader of Zimbabwe, ran on the slogan "Vote for me or I'll kill you and your family." He got 99.9% of the vote because the people knew he was a very honest guy.

doctors lie all the time. it's not about lying to your attending about how much you like ob/gyn. it's about not lying about a patient and putting their health in jeopardy.

what part of rrr no m/r/g implies anything about a complete heart exam? i don't see how that's an example of lying. no murmurs, rubs, or gallops implies nothing about thrills or jvd. you don't have to do a full exam to say that the rhythm is not brady/tachycardic or is not afib. and contrary to your assumption, auscultating without a suspicion does have value, like if your obese patient goes into afib postop. catching it early means you can diagnose and treat a potential heart attack early on, or prevent that patient from throwing a clot. and lastly, have you ever worked with cardiologists? how many times do you think they palpate for thrills? i would guess it's far fewer than the number of echocardiograms they order.

 

[SLUser11]

I think I'm growing out of the SDN 🙁

In the past, I would have LOVED to lay into somebody like Telemachus and tell him how much he sucks, etc (as I see many of you have done).

But now, I couldn't even keep the attention span to read more than 40% of this thread. 😴

Unless this website starts getting fun again, I'm going to have to actually be PRODUCTIVE when I'm at the library.....and I really don't like that idea.

 

[jennyboo]

I'm your intern, or at least I will be as of next month.

Hmm, someone's getting a little ahead of himself.

 

[jrisley]

This is excellent. Thanks for voicing what so many of us feel....

Please, Sophie, tell me you're an Osteopath. This is the only way your post would make any sense at all...

 

[Zuwie]

doctors lie all the time. it's not about lying to your attending about how much you like ob/gyn. it's about not lying about a patient and putting their health in jeopardy.

what part of rrr no m/r/g implies anything about a complete heart exam? i don't see how that's an example of lying. no murmurs, rubs, or gallops implies nothing about thrills or jvd. you don't have to do a full exam to say that the rhythm is not brady/tachycardic or is not afib. and contrary to your assumption, auscultating without a suspicion does have value, like if your obese patient goes into afib postop. catching it early means you can diagnose and treat a potential heart attack early on, or prevent that patient from throwing a clot. and lastly, have you ever worked with cardiologists? how many times do you think they palpate for thrills? i would guess it's far fewer than the number of echocardiograms they order.

I've worked with a great cardiologist, who teaches a class on cardiac exam at my school and he said that you will never hear something unless you are listening for it. He also said that without good clinical evaluation which involves a complete exam an echo is worth doodley squat.

 

[Sammich81]

I've worked with a great cardiologist, who teaches a class on cardiac exam at my school and he said that you will never hear something unless you are listening for it. He also said that without good clinical evaluation which involves a complete exam an echo is worth doodley squat.

Of course he said that. Every specialty thingks its pet organ is far and away the most important. Talk to critical care/pulmonary guys. If you don't inspect every waveform on the vent, complete with inspiratory and expiratory pauses, you haven't evaluated the patient worth "doodley squat', as you say.

 

[Dr JPH]

If you want to continue acting this way perhaps SDN isnt the place for some of you.

That is true mostly for you Telemachus. Consider this your first and only warning. I hope your maturity would have grown in the last 4 years along with your apparent worldly knowledge.