Being the med student on Internal Medicine makes me understand how most aspiring novelists must feel. NOTHING I WRITE WILL EVER BE READ.
Sure, I can understand flipping past the “MS-III” note and glossing over the H&P. Med student notes are dumb. I accept that.
But dude, if I spend two hours with a patient, going through their drug list and a Pill Identification Book to par down the “every drug prescription every doctor has ever foisted upon them” list from the EMR into a “what they actually take” 4-item list: please, please, read my drug list.
The EMR drug list some of them insist on using doesn’t tell them that the patient stopped taking warfarin 3 months ago. Or that when the hospital changed the hypertension meds two months ago, the patient got confused and just kept taking the old ones. Or that they’re taking tylenol instead of aspirin because “it’s the same main ingredient, right?”
I feel like I’m trying to sell my residents something. I have these revised drug lists for my patients, but no one wants them. And I’m all, “I swear, this has information you can use!” and the residents are all, “Ah, no thanks – I’m good with the one on the EMR.”
(Yeah, okay, I’m sure they’re right about not needing my drug list. It’s just a sad reminder of how little I matter.)
(… Stupid robot EMR.)
Vignettes from Internal Medicine
Two days ago.
Me: “And on abdominal examination, the patient had significant right lower quadrant pain on light palpation.”
Resident: “OK. Let’s figure out how to correct the main diagnosis”
Me: “… Today the patient has significant right lower quadrant, left lower quadrant, and left upper quadrant pain on light palpation. And new-onset involuntary guarding.”
Resident: “OK, good presentation. Thanks. Let’s figure out how to correct the main diagnosis and the mysterious transfusion-dependent anemia.”
So today I gave up on the idea that my presentation would ever mean anything in terms of this patient’s care, and pulled the “Oh, hey, I’m not sure if this is involuntary guarding or not – can you examine the patient and tell me?” card.
And of course then the patient got a DRE and abdominal CT.
At this rate, I’m going to start turning my patient presentations into interpretive showtunes to see if my voice is in a special frequency only I can hear.
(If this hypothesis turns out to be wrong, watch out. “Patient Presentation: The Musical!”, coming to a ward near you.)