After some deliberation, Johns Hopkins Hospital leadership has determined that their medical interns may wear long white lab coats. Until now the short white lab coat defined medical interns and the age old pecking order of postgraduate medicine in Baltimore. Woulda killed to hear that debate. Although I know how important this stuff can be to young ... Continue Reading about Small Doctors in Big White Lab Coats
Medical Signs
Medicine is a dicipline of uncertainty. So clinicians are always looking for indicators of certainty. We’re looking for signs. Medical signs. The psoas sign indicates an inflamed retrocecal appendix. A sentinel node is a classic sign of dissemination of cancer into the chest. The Cheeto finger sign (telltale orange fingers reflecting the recent consumption ... Continue Reading about Medical Signs
The Zone of Medical Uncertainty
Daniel Crook, @EMSafe dropped this in twitter a couple of weeks back: I realise that I have had to learn and do medicine in 7 different ways: What the book says What we actually do What the course says What the College/exam wants What the boss wants What the evidence says What other people will do who don't know the evidence I’ll add this ... Continue Reading about The Zone of Medical Uncertainty
Keep Mama Happy
“We’ve gotta keep Mama happy” I hear this from time to time from pediatricians. The idea is that if we don’t give a mother what she’s looking for, she’ll walk. As a resident I had a preceptor who loved to pull me aside to teach me the ‘inside baseball’ of pediatrics. One day after prescribing antibiotics to a child with a runny nose, he remarked with a wink and ... Continue Reading about Keep Mama Happy
Interrupting Patients for the Right Reasons
Not long ago I entered an exam room and was met by a mother who immediately began talking. From the chaotic feeding to her sequence of formula roulette and the staccato of the baby’s cry, she delivered a near full history of present illness in the span of 45 seconds. And all with one breath. While I was impressed with her delivery, I couldn’t keep up. So I ... Continue Reading about Interrupting Patients for the Right Reasons
Medical Tests – The More You Order, the More You Explain
I spoke with a young pediatrician recently who complained about her late hours in the office. A lot of calling patients with questions about labs. On cursory review, she seems to do a lot of medical tests. It makes sense. Here’s the math: Two sessions per day of 10-12 children per session and everyone gets a comprehensive metabolic panel (as an example). 48 hours ... Continue Reading about Medical Tests – The More You Order, the More You Explain