Today was my last day to present at morning report (since Elizabeth and I are finished with inpatient care), and I talked about the little boy with the brain tumor. Arash later told me that he had seen the same little boy at the PCP office last week, and we both agreed he was a cute kid. At Ortho Clinic, Dr. T taught us about knee disorders briefly before the first of his patients came in. ER didn't start for another hour, so I went to the library while Elizabeth went to pathology.
ER had a very slow morning, with the first cases coming shortly before lunch. One was a toddler who presented with seizures because his glucose levels were 31, which was way too low. When we arrived at the ER after lunch, it was packed. The patients' charts are color-coded green (non-urgent) and orange (more urgent), and all orange cases are seen before green cases. My first case was a kid with asthma, but I got nervous when one of the residents followed me into the room to supervise. My next patient was a toddler with fever; she started screaming and crying during the exam and was inconsolable until after I left the room. My last patient was a teenage boy who broke/sprained his ankle after landing on it wrong on a trampoline. I actually found myself able to relate to him since I'd sprained my ankle before. As a result, I was able to come up with an acceptable treatment plan for him =)
The way the ER is run: charts are placed along the wall, we take them and get an H&P on the patients, present our case to any of the attendings, and then accompany our attendings to talk to the patients again. The problem: too many patients, not enough attendings. There were only two attendings this afternoon, and with two medical students, at least three or four residents, and many nurses lining up to present cases to them, they were totally swamped. Not to mention there were more patients than rooms available, so many patients had to wait hours before being seen. I still have to learn how ER H&Ps differ from IP H&Ps, but I'll be in the ER all week so I think I'll get the hang of it.
4 comments:
Hey I didn't know ER H&Ps were different from Inpatient H&Ps. Let me know what the difference is.
Do you feel weird when telling patients you are the student doctor? I always tell them "Hello, I am Student doctor. I will take your history and do an exam, and then the Doctor will come and get you fixed up".
I just feel like a lot of patients think I am wasting their time, or that I am going to miss something a real doctor would find. Kinda sucks.
Here's another ER story: patients wait a long time, and things can change in that time. My asthma patient wasn't wheezing when I first examined him, but he WAS wheezing by the attending got to him 3 hrs later. The grandmother said, "But she (talking about me) said there was no wheezing!" and the attending said, "She's still in training! That's why I check on her." ....ouch.
Every time I go to a patient's room, and say "I'm student doctor Jennifer", they automatically assume I'm the doctor. Perhaps outpatient is a lot different from inpatient. They have no problem repeating their story to anyone. But they also see 2-4 different doctors coming in at different times of the day to check up on the patient.
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