Sunday, April 17, 2011

Tales from Intern Year

Resident: "I'm concerned with this patient's symptoms, she might have a pulmonary embolism."

Me: "I got an EKG and it showed sinus tach."

Annoying medical student: "Did you look for the S1Q3T3?"

Me: "Shut the fuck up, med student."


(OK, I didn't really say that. But I thought it really hard.)

33 comments:

  1. You do realize that a lot of your readers are med students, don't you?

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  2. Med students read this????

    In that case, med students are all beautiful perfect little flowers, and I have never once met a med student who was annoying, overly competitive, or lazy.

    Better? :)

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  3. There are over-competitive or lazy. I probably flit between the two, usually somewhere near the middle. We know we're annoying as hell, but console ourselves that we're not as bad as our colleagues who are usually annoying to us even.

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  4. Pfft. If he was really a gunner, he'd know that only 20Q% of PE's have the S1Q3T3.

    Now THAT'S being over competitive and annoying.

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  5. As an entering medical student, my lack of caring about sinus tachy or PE just really became apparent. Haven't even started and my lack of gunnerness (if that's a word) is already here. Now if the patient had a biopsy and it was a 20% variant of a type of cancer....

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  6. I think annoying med students are more annoying to other med student than to anyone else. At least they attempt to be courteous to residents.

    I've never seen a S1Q3T3 on an actual human patient.

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  7. But they have all this knowledge and just want to share... Blech.

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  8. i always love your cartoons, but man, this is just so mean.

    as a med student, I always tough to read your rants, or in this case, short hate filled thoughts.

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  9. I find it incredibly interesting that I've made posts complaining about residents, attendings, nurses, premeds, patients, my own doctors, my cleaning woman, book clubs, etc. Yet the only time when anyone acts offended is when I say something about med students. Why is that?

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  10. We're especially sensitive apparently. : )

    I thought it was funny...

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  11. As a med student, I thought it was hilarious. Keep it up!

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  12. I guess fizzy doesn't know what it's like to be a medical student and have residents picking on her...

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  13. I'm a med student and I thought it was brilliant haha. Keep em coming Dr. Fizzy!

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  14. I'm not an MSIII yet, and I know NOT to ask the intern if she checked x, y, or z, IN FRONT of her resident. If you really want to know, you ask in private, where you can't make the intern look bad...

    Getting on an intern/resident's bad side is not where a medical student wants to be!

    P.S. I thought it was funny and you shouldn't worry about offending people :)

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  15. StudentDoc: I actually found it obnoxious not from the perspective of it making me look bad, because it was just me and the resident (who had just one year on me), but I was irritated more from the perspective of: I have had five hours of sleep in the last week, my patient might be about to die from a PE, and the med student found it appropriate at that moment to try to look clever by bringing up a finding that NOBODY cares about.

    If the student had asked, "What is the patient's O2 sat?" or something relevant and not show-offy, I wouldn't have been annoyed.

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  16. We have the same thing in pharmacy. As a student, I just thought it was annoying when my fellows showed off. In practice, we let our students go into the OR to observe surgeries (I think it's important they know what's going on). One student we had kept pestering the surgeon about his sterile technique, about how he should do this and that, and "we learned that ...." Needless to say, the surgeon was not pleased. You're a pharmacy student. Shut up.

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  17. People showing off just for the sake of showing off is annoying, no matter what field or stage of training you're in.

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  18. I think most of us med students realize we don't know anything are are mostly in the way, and we hate the obnoxious show-offy gunners as much as the residents and attendings do.

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  19. Maybe he wasn't trying to be annoying or a "gunner" but was genuinely interested in if this was seen. Assuming that the student learned in school that this pattern is seen with PTE and assuming that the patient was hooked up to an ECG, why wouldn't the student want to know if the pattern was there? I'm a vet med student and we are specifically told to ask questions of the residents. And, frankly, most of them are very happy to answer them - it keeps them on their toes and they can help future doctors.

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  20. I'm a med student and this is one of the funniest things i've read on this blog. Hilarious. Thanks for posting!

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  21. Med students are great at remembering the shit that has zero clinical usefulness. I know b/c I was one of them.

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  22. Don't let the med students' criticism get to you Fizzy. When they are in the situation of facing a possibly fatal patient issue and having to make decisions with only a couple of hours of sleep and the med student does something similar, it will suddenly click. They will have the same thought.

    On another note, I had a patient with a PE and the ECG showed sinus tach and S1Q3T3. That EKG got copied and passed around to other residents as proof that it isn't an urban legend. Even attendings got a little excited :)

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  23. Lori: Maybe it's hard to articulate exactly why that comment from the med student was so irritating, but suffice to say, it's a little obnoxious to bring up a rare and basically irrelevant finding when we're trying to figure out what to do about a seriously ill patient.

    Melissa: I'm not bothered. I just think it's weird that people were offended by this post.

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  24. I think the appropriate response is "Tell me 3 more causes of S1Q3T3".

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  26. Oh, no S1Q3T3? No need for imaging or heparin then. Must be just stress :-)
    I have never ever seen S1Q3T3. And almost none of the "classic PE presentations" turn out to actually have it. Only the one you don't work up for PE... :-/

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  27. I've been reading your blog for a few months... I LOVE IT!

    All your rants about medical students and your experience just shows me what NOT to do to piss off my residents and attendings... haha...

    I'll be a 4th yr med student soon in the Philippines... can't wait to see what stories I'll end up having and blogging about... haha

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  28. +1 to Aaron.Johnston! That is totally the appropriate response!

    As far as med students go, whenever I had a bad day on wards, I would remind myself of the Laws of the house of God.

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  29. I'm reading my EKG book right now and just finished the PE section, where they talk about S1Q3's in patients with PEs. I thought, "Sweet, I'm totally going to look for this in the next PE I seen", and then it dawned on me that this is exactly what you were making fun of in this post. Maybe the med student was being a dick gunner, but it might have been just an honest instinct to see something that was talked about in the book.

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  30. My first thought was, "well sinus tach is the most common EKG finding in PE, with other clinical signs why would you need more than that...?"

    I am a MSIII, and i was NOT offended, i worry about doing that exact thing on a regular basis :D

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  31. I'm a little late getting here but I'm an MSIII and when I read this little blurb (which make me chuckle heartily) I was suddenly struck with insight thinking "oh no! Do I do this??" I keep my mouth shut and stay in a corner 90% of the time so no, I think I'd spare you if I happened to be following you or any other resident. Phew!

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