Dr. Critical: So what do you think he has?
Me: I don't know
Dr. Critical: So what do you want to do about it?
Me: I don't know because I don't know what he has
Dr. Critical: Well, what would you do if you were the attending?
Me: It seems like a legit complaint so I'd probably refer to a foot&ankle specialist
Dr. Critical: OK, smartass. What if you were the foot and ankle specialist?
Me: Then I'd probably know what he has.
I really don't think my answers were unreasonable there.
I'm not saying the patient didn't have a problem, but I have no idea what it was. And, as any good orthochick who has completed the PGY-2 or greater level of training will tell you, if you don't know what something is, the wrong answer is to order more imaging studies. You don't order an MRI to give you a diagnosis, you order one to confirm your diagnosis. I learned a while ago, if you don't know what you're looking for, don't go looking for it.
Also, Dr. Critical had no idea what the patient had either. My guess was "sinus tarsi syndrome" he said that was a crap diagnosis but he didn't have anything better, and the whole thing was sort of a wash.