Last Thursday at my off-site hospital, I started off on the right foot. I got there early, and remembered to bring all my toys.
I sat down with the attending/preceptor to go over the H&P I turned in last week, and that’s when things started to take a turn for the worse. My classmate who was assigned to the same site went into another room to go over his with his attending. While my guy was on the phone, yelling at someone, I heard the other guy offering him good advice about what format he should use. My guy sat down and the next five minutes were, What! What is this?! I don’t even know what this means, why did you put this here?! This doesn’t go here, why did you do this. Telling him I followed to sample the school gave me was pointless.
So I followed him to the floor where he introduced me to the patient I would be working with for the rest of the morning. He left (thank goodness). And it was just me and the patient (not so thank goodness).
There were some mishaps. I spent about five minutes fumbling through the drawers looking for the little disposable black cone that goes on top of my otoscope, at the same time trying to make awkward small talk. Have you been outside lately? The weather is beautiful! (He has been confined to a hospital bed for the last seven days, smartypants.) After all that, while looking at the first tympanic membrane the damn thing ran out of charge. I went back to his heart sounds at least four times (they were really hard to hear, I swear), but the patient humored me. He was very ill, in pain, and was honestly really very nice to put up with me as I made my way from his head to lungs to heart to abdomen to extremities in no particular order.
But I did it! And it was time to give my report to the attending.
In the middle of the HPI I was cut off:
Name some causes of dyspnea! Okay, pulmonary embolus, myocardial infarction… NO! (really??) Why don’t you do a report on dyspnea for me next week? Sure.
The patient reports three previous hospitalizations within the past three years for similar symptoms… NO. You are wrong, it’s more like eight. GO ON.
And so I went on.
What about his meds?!! Why didn’t you record his meds?!! He couldn’t remember them and told me to look in the chart (which, for your information, you forbade me to look at).
Our patient has right sided heart failure. Cor pulmonale. Ah right, we just learned about that this week. Great, why don’t you do a report on that for me next week too.
Really looking forward to this Thursday.