I shrunk the fetus.

So I was on the MFM service the other day and the attending physician who is very well respected and a talented clinician was supervising my work. I had worked a couple of shifts with him and I was slowly proving to him that I was not completely inept. However I still had a long way to go. This doctor is well known among the students and the residents for having a very "in your face" style of medicine. You had to have thick skin and realize that this is just how he taught. He likes to ask you progressively more difficult questions and when you miss one he goes overboard; "doctor you have disappointed me!", "Unacceptable, how do you not even know the very basics?", "you are a danger to the medical community", "did you read anything?" "what is wrong with you?",  "You do not know anything!" Following his hoopla he begins to teach you like no other can. He has vast amounts of experience and really knows medicine from every angle. More importantly he takes the time to teach you and he really does care about your learning and knowledge.

He gives you a lot of autonomy to perform the ultrasounds and make all the measurements of the fetus. Of course, he checks your work and determines if you are doing the ultrasound correctly. Many students become nervous on their own and while taking measurements / pictures with the ultrasound they can back into the numbers by figuring out how old the fetus is and what the fetus's measurements should be. Students can "cheat" this way and everything will be correct if the fetus has progressed normally. If you have a fetus and according to your ultrasound the fetus is measuring small for it's age you can adjust or re-measure and try to get normal measurements. If you report that the fetus is small according to your ultrasound measurements and when he checks the measurements he finds the fetus to be normal size you are going to get an earful about not knowing / understanding how to do ultrasounds. Many students will "fudge" their numbers. 

I had a 22 week pregnant mother who presented to have her baby measured and evaluated via the ultrasound. She had had a normal pregnancy up until this point. I made several different measurements and they kept coming up small. I looked in the chart and saw that the fetus had normal measurements 10 weeks ago. I continued to work the ultrsound and finally had confidence in my measurements and recorded my findings. I stepped out of the exam room and found the attending physician and explained that the fetus was small. The doctor immediately squawked "you have no idea of what you are doing! I am sure the fetus is normal, go remeasure it!" I replied; "actually I think that this fetus has asymmetric intrauterine growth retardation (IUGR)and I am confident with my measurements." In a huff he ran to my exam room and began to ultrasound the patient and her fetus. As he was doing this he continued to explain that I do not know what is going on and I need more practice / experience. I noticed as he was measuring he kept getting similar measurements to what I had found. He would quickly remeasure and check again. Finally after realizing my measurements were accurate he blurted out: "Doctor you have shrunk the fetus! What did you do?" This baby has asymmetric IUGR. 

On his way out of the room he said "good job doctor! at least I know you do not cheat with your measurements, which is more than I can say for a lot of the residents! Nice catch!" "Now get back to work!"