3 Things I Learned Today

1.  If you’re pimped on a statistics question (“How sensitive is [random test]?”  “What percentage of [Disease X] presents with [symptom]?”) and you do not know the answer, guess either 20% or 80%.

Attendings rarely ever ask about 50/50 things – they’re asking you because the number is either unexpectedly large or small – so guessing 20% or 80% is almost guaranteed to put you within 10% of the right answer.

(Not that it matters how you answer, since the attending is only asking so he can give you a short speech about [random test] or [Disease X] – but it’s a cool trick.  Works 80% of the time.)

2.  One excellent presentation can make up for at least 5 days of looking like an idiot.

3.   Pulmonary Embolism should be on your differential diagnosis if your patient has any of the following risk factors:
* any symptom above the diaphragm.
* any symptom below the diaphragm.
* lungs.

Also, a really nice stock phrase for your patient presentation is “We could order a D-dimer, but we essentially know it’s going to be positive in this patient – so we may as well save time and just do a V/Q scan.”

(The D-dimer test will be positive if the patient has any of the following:
* heart problems.
* lung problems.
* cancer problems.
* any problems that could possibly be causing some stress, such as “is currently hospitalized.”)

4 thoughts on “3 Things I Learned Today

  1. Number 2 is true in pharmacy school too. I had an awful rotation where the preceptor expected us “to be able to do [her] job” in matter of a few weeks. It was my second rotation ever, the first time I’d ever been a hospital. From day one, she would constantly ridicule me in rounds. At mid-point, she told me I was failing that it was good for me because, “by repeating, you’ll just get more experience.” (we’re allowed to repeat one), and that there was nothing I could do to pass. She said she had already told the schoolI was failing so they could schedule me somewhere, wtf. Some would have slacked off. I worked my butt off for the rest of the rotation and ended in one killer presentation for grand rounds. Passed with a B, and she said it was mostly because of my presentation.

  2. You should also commit this monologue to memory:
    “GAH! Who decided to order a d-dimer on this patient!? I ordered it!? Why would I ever do that!? What the hell am I going to do with her now!?”
    – end scene

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