TONY: Do Better

Pop quiz hot shot:  A 27-year old man walks into the emergency room.  Actually, scratch that—he rolls into the emergency room in a wheelchair.  All you know is that he woke up this morning with knee pain so severe that he could not even walk.  What do you do?  WHAT DO YOU DO?

Well, if you’re a second year med student, you’d better have a lot of questions to ask.  You would ask about the pain—its character, its severity, when it started, what makes it better/worse, whether there are any associated symptoms.  You’d get a thorough past medical history.  You’d get a social history.  You’d get a family history.  You’d get all of the information that you’ve been taught to obtain, and you’d feel like a champ because you’ve finally reached that magical stage in med school where you can form a differential diagnosis in your head as you talk to your patient, and ask questions that really are pertinent.

So, you’ve gotten a thorough history from your patient, taken copious notes, and narrowed your differential down to a small handful of possible causes of this man’s knee pain.  So, you’re done right?  False.  You’re a med student.  As such, you need to present your patient to your attending physician before any sort of treatment can commence.  Sounds easy enough, right?  You already have all of the information in front of your face—telling another doctor about the patient you’ve just seen can’t be rocket science, can it?  Or can it?

The reality is that your attending physician does not have a lot of time on his/her hands, so they need you to be able to present ONLY the pertinent information.  Thus, even though you may be dying to tell somebody about how you learned that your patient owns the largest tick colony in the western hemisphere, your attending will not care (unless of course these ticks tend to escape from their aquariums, burrow into kneecaps, and have babies in synovial fluid).  Learning what to leave in, what to leave out, and how to structure your presentation of your patient’s story is an art that all doctors work to perfect over years and years of experience.

So clearly, in order to get us prepared for the wards, we are learning how to present our patients to attendings.  Let me tell you this up front—you will be bad when you start trying to do this, and that’s difficult for a perfectionist, type-A personality  to deal with.  I’ve been cut off, I’ve kept too much information in, I’ve left too much information out, I’ve completely missed diagnoses, and pretty much been made to feel like this chump kid:

Yes, C-Q has gone out like a punk in front of his mentor doctor.  And no, it does not feel good.

Take home message?  This whole ‘being a doctor’ thing really is a lifelong learning experience, and as a second year med student, we are only beginning to realize what that really means.  You sit in class for over a year, you learn clinical skills, you learn the intricacies of the doctor-patient relationship, and you think you’re starting to get somewhere—all of the information starts to come together bit by bit, and you’re starting to feel somewhat useful in clinic.  But make no mistake:  you’ve still got LOTS to learn.  Just try your best not to get too frustrated—if your teachers are any indication, you really will be good at all of this stuff down the road.