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.
When the emergency department is inundated with people, every service feels the pressure. Consults are requested, teams are pressured to admit or move patients. The night seems endless.
Last night, the emergency department was packed to the brim. I had never seen it so busy. There was no particular cause for this influx, no mass casualties or public event gone wrong; people just got sick at the same time for different reasons.
The night was steady until three in the morning. Many of my classmates on other services were present as well seeing patients. In those hasty moments between cases, we caught our breaths and checked on each other.
The key word to all of our conversations was “surviving.”
With great power comes great responsibility.
This quote comes to mind when I think about the new addition in my toolbox. I now have the authority to prescribe narcotics with my triplicate prescription pad. These are highly regulated substances for obvious reasons.
I must ensure that I dispense them appropriately. More crucially though, I must keep my prescription pad safe from theft.
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.
30 grams a day except on Sundays.