Monday, March 26, 2012

Tales from Residency: How to present a patient

Attending #1: "Okay, who's your patient?"

Me: "This patient is a 58 year old man with 5 years of axial lower back pain who--"

Attending #1: "Any past medical history?"

Me: "He has a past medical history of hypertension and asthma."

Attending #1: "Okay, so you should say, 'Patient is a 58 year old man with a history of hypertension and asthma with 5 years of axial lower back pain.'"

Me: "Okay, sorry."

Later that day....

Attending #2: "Okay, present your patient."

Me: "This patient is a 49 year old man with a history of hypertension, arthritis in his shoulders, and vicodin abuse--"

Attending #2: "Okay, stop. What's he here for?? You should say that part first."

You know, it's not that hard to present a patient. Unless you have to do it slightly differently to comply with the personal preferences of every single attending in the clinic. And even when you include every pertinent detail in the presentation, he'll ask you, "Has she tried NSAIDs for pain?" And then shake his head accusingly because you left out such an important detail, even though you actually mentioned that the patient had been taking ibuprofen but the attending just wasn't listening.

9 comments:

  1. I experience this allll the time. It really is quite annoying.

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  2. I love when attendings ask you questions that you've already answered and then make you feel stupid for missing things that you didn't actually miss. Particularly when I'm calling them at 3 am and all I really want to do is curl into a ball and fall asleep. No wonder residency is so much fun.

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  3. Once when an attending said something like this to me, I (inadvertently) said, "Oh ok, you like it like XYZ." And he said, "Oh, you mean you think XYZ is a PERSONAL PREFERENCE??"

    Fortunately he had a sense of humor and was kidding. Mostly.

    Also, what SD said.

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  4. Yes! I had an attending who hated it when you said the patient "admits to" x,y,z or "denies" x,y,z. He said it made it sound like we don't trust our patient, and "we're physicians, not lawyers". I can see tat, but considering lots of case reports and stems of board review questions use that terminology, I think physicians can sound like that, too. And god forbid you used your hand to gesture toward your body to illustrate a location, like right upper quadrant. "You're not a mime!"

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  5. Haha, speaking of which...

    http://www.cmaj.ca/content/183/18/E1356.short?related-urls=yes&legid=cmaj;183/18/E1356

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  6. It can be worse as a student, every 4-6 weeks there is a new batch of attendings and residents to learn the "universally followed standards" of.

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  7. Yeah, since starting rotations, I've rapidly realized that having to deal with and cater to each attending's various personal preferences is one of the most difficult things about being a clinical student. I guess dealing with people's personalities is just a part of work life...

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  8. I've had this exact same thing happen... but with the same attending! Super frustrating

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