We're Better Than We Think

[WilcoWorld]

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I had another one of those shifts yesterday, where several patients came in sick, but I just couldn't figure out precisely what was wrong with them. So, I did the EM thing: stabilized, ordered studies and therapies based on my differential Dx, and admitted them to the floor/PICU/obs.

Today I logged in to see what those REALLY smart inpatient docs had figured out. Basically, this is what I found:

"Hmm, this patient is sick. I'm not sure why. I've added an ESR and continued the care started in the ED."


We're better at medicine than we often give ourselves credit for. Stand up straight and hold your head high.

 

[Jabbed]

I kind of knew that it was going to happen eventually, but I do have a bit of a chip on my shoulder about practicing EM rather than some sub-specialty. The Monday morning quarter-backing, the 'specialist' asking why I did this but not that or changing my treatment plan, and just the general sense that I'm not really an expert in anything.

It's all false. Following up on cases over several weeks/months and you realize that the 'specialist' is wrong just as often as he is right or that he isn't following modern practice patterns. People can question why you did xyz and not abc, but the answer is that you're a highly trained medical professional and whatever you do is considered specialist management of the acutely ill undifferentiated patient. If anyone disagrees, they can kindly come in from home and assume care of their new patient.

 

[WilcoWorld]

I kind of knew that it was going to happen eventually, but I do have a bit of a chip on my shoulder about practicing EM rather than some sub-specialty. The Monday morning quarter-backing, the 'specialist' asking why I did this but not that or changing my treatment plan, and just the general sense that I'm not really an expert in anything.

It's all false. Following up on cases over several weeks/months and you realize that the 'specialist' is wrong just as often as he is right or that he isn't following modern practice patterns. People can question why you did xyz and not abc, but the answer is that you're a highly trained medical professional and whatever you do is considered specialist management of the acutely ill undifferentiated patient. If anyone disagrees, they can kindly come in from home and assume care of their new patient.

“whoever judges others digs a pit for themselves.”

 

[betamale]

Good job, what I've noticed is that if you do the right thing by the patient, most of the time your instincts will be correct. I may not figure it out 100% of the time, but my goal is never send the sick ones home. If I crack the case, well that's a bonus.

 

[Arcan57]

Years of following the cases that stumped me in the ED made me realize that most of the stuff I "miss" is picked up as a result of downstream testing not available in the ED. And the vast majority of cases I don't have a clue on in the ED leave the hospital a day or two later with more stuff ruled out but no definitive diagnosis.

 

[Apollyon]

I used the golf analogy for years: we tee off, and try to keep it on the fairway. Occasionally, we'll go into the rough or out of bounds. But, usually, we're pretty much on target (and some of y'all are heavy hitters - gunga galunga!). We get it to the green, and call someone else to putt. Uncommonly, we'll hole out, but, usually, not. Now, if the person putting takes 3 or 5 or 10 putts to hole it, that's on them. But, we set them up really well.

Or, alternately, "Either I know what it is, or, I don't know what it is, but, I know what it ain't!"

 

[pkwraith]

If anyone disagrees, they can kindly come in from home and assume care of their new patient.

Nah, they would just prefer just to send your to Peer Review for anything they perceive you did wrong from home