I recently had the opportunity to work with a medical student while on call. I had received notice of a ward issue to see that sounded appropriate for his level. I asked him to go first and that I would join him shortly thereafter.
When I arrived, he briefed me on the problem at hand. When I asked what his thoughts were and what he wanted to do, he supplied me with a full and extensive workup for a simple case of pain.
At one in the morning, I reminded him that our job was to make sure nothing life threatening was happening, that we have done enough investigations to aid us in that cause, and to keep patients alive until the morning.
Without the backup, manpower or support, we were not in the best position to start investigating and treating everything fully, unless something truly worrisome was suspected.
Put simply, our job boils down to a half measure.
In a previous post I highlighted some positive feedback I received about my history taking. I received a lot of comments about sharing what I was doing. I think that history taking is a very individualized process. In all honesty, there is no right or wrong way to take a history. Each person’s style is a reflection of their thinking process, their knowledge base, and their comfort level and that naturally evolves over time.
Having said that, this is what I generally do now.
I really like your approach to asking those questions…I might steal that and use it myself.
Surprising feedback I received today about my history gathering method.
When you begin examining the child of two doctors and they watch your every move with scrutiny.
When you see patients with scabies or pink eye and you feel the creepy crawlies just itching under your fingers and eyes for the rest of the day.
…Embedding a Starbucks store right inside of a hospital is a genius.
These stores are make a killing of my wallet.
The challenge of my current schedule is that I must juggle my responsibilities between my core rotation and those of my clinic, to which I am obligated to spend time as well.
Sometimes it means missing out on some good learning opportunities due to conflicting schedules. Other times, the days off of one schedule coincide with the days on of another. I can be particularly hit hard if, like today, the day could have been spent sleeping post night shift.
Thankfully these scheduling anomalies are few and far between. However, when I think about how well established the challenges of balance are in residency, having an awareness of these issues can go a long way towards improving resident resilience.