Internal Medicine docs, like I'm going to be, are called "fleas" because both are the last things to leave a dead body. That's obviously a derogatory term, but like "yankee" the term has been embraced by its targets. Fleas can be a pretty nerdy bunch, so I tend to fit right in.
I was reminded of this Friday. I saw a patient, whom I was convinced needed a colonoscopy, because her symptoms were strongly suggestive of cancer. My resident didn't want to order one. So our conversation went:
Well, if you don't want to get the C-scope, I don't know how sensitive the test it, but you could just culture her blood for Streptococcus bovis, since that's associated strongly with colon cancer.
Wow Nathan, you are destined to be a flea.
See, that's a pretty insubstantial footnote in the average medicine text, and an almost ludicrously wild shot in the dark, but I was trying to surmount obstacles with knowledge.
I love it.
My attending agreed with me though, and the patient got the C-scope. Good thing residents don't write my grade.
Subscribe to:
Post Comments (Atom)
3 comments:
Well, no results back yet. The problem with being a medical student is that you are never in one place long enough to follow a given patient. Her scope is scheduled for later this week, by which time I'll be gone.
And I fully intend to be a good one. I think, in internal medicine, I've found the best place to use the vacuum cleaner mind G-d gave me. I remember all the bits everyone else forgets.
But as far as the patient is concerned, I'd be very surprised if she doesn't have cancer. You're a nurse, right? So this patient's unprompted history included a 40lb unintended weight loss over the past 6 months, night sweats at least twice a week over the past two months, a decrease in stool caliber to "pencil thin" and a family history of cancers. Surely that deserves a C-scope, right?
Oh man, internal, better you than me! Oh, and yeah, good call on the scope... what idiot wouldn't do a scope with b-symptoms and evidence of a partial obstruction?
I think family medicine docs are overly cautious. My resident actually wanted to give this lady laxatives and iron and see her back in a month.
Post a Comment