jack of all master of none

I pose this post as a question to readers of this blog or those who stumble across it by accident. Please feel free to comment and add your thoughts or opinions.

As I finish up medical school and get ready to start residency I have found myself in many conversations with friends, family and others where medical topics are discussed. Often a question will be directed at me directly. Sometimes it is a group discussion and I may give an opinion or a thought regarding a medical topic within the conversation.

I am a little sensitive to the idea that I amy come across as pretentious "know it all" large ego pride filled "doctor" when discussing medical topics. Sometime I have caught myself starting a comment with the words "I tell patients......." or "Often I explain ..... to my patients ......" For example, the other day a group of my friends and some family members where sitting around the table and discussing life when one friend brought up the subject of headaches. Everyone was talking about different things they have heard or have read about different types of headaches. Some shared their own experiences with their headaches and everyone was casually discussing the topic.

In this particular group I was the only person who works in the healthcare field. At some point in the conversation I made a comment that started with "I like to tell my patients, ....... about their headache and ..... about their treatment options." I was asked a couple of medical questions about headaches and the conversation continued with others sharing their knowledge or comments about headaches. Eventually we moved onto a different non-medical discussion about something else.

Ok, so where am I going with this and what am I babbling about, what is my point? I do not want to come across to people as a pretentious egomaniac. I was not making comments out of turn or interrupting the discussion or correcting anyone and maybe I am worrying too much about it but this is my question.

Do you think it sounds pretentious to start a comment or statement when discussing a medical topic or even a medical question directed to me by non-medical people if I start the comment or response with "I tell my patients......"?

I have not had any bad reactions from anyone or looks from people that would suggest that they think I am acting high and mighty but I want to avoid sounding like a egotistical know it all. On one hand I think when I start a statement with "I tell patients ......" it may sound like or come across like I am saying I have treated thousands of patients with (fill in the blank), when in fact I am trying to say "with the patients I have seen or treated with (fill in the blank), I have found..." In some cases it may have been several patients, in other cases it may have been only a small number of patients that I have seen thus far in my training.

Feel free to share your thoughts and comments and suggestions. I have been seeing and treating (under supervision) patients on some level / degree for the past 2.5 years across nearly every field of medicine in 2 week to 8 week blocks and have directly or indirectly worked with 1000's of patients on some level with lots of different diseases. For example when I did my neurology rotation I worked with at least 100 patients on some level with headaches.

You kind of get to see a little bit of everything on some level during your rotations but are not an "expert" on any of it. It is like being a jack of all trades and master of none as you wrap up your medical school training and get ready for residency.

I am "wet behind the ears" and I am very young in my career / life long training. I have a long way to go and I am certainly not an "expert" on headaches or any other illnesses at this point. The nice part about medical school is that during your clinical training year you get to see a little of everything as you rotate through all the different specialties but you really start honing in on your "expert" level training during residency which I will begin shortly.

I do not want people thinking "he thinks he is hot stuff and is in the beginning of his training and talks like he has seen thousands of patients with (fill in the blank)." I never want to be one of those doctors that thinks he / she is a god and then end all be all expert. I certainly do not want to come across as a pretentious, pompous "know it all" either.

Let me have it and give me your thoughts. Should I stop saying "I tell patients ......" or am I overly sensitive? If you think I should avoid saying, "I tell patients ......" what would be a better way to convey a response or comment regarding a given medical topic?

Thanks.

Research and Waiting

Currently I am doing 2 week elective and senior independent research paper. In other words I have 2 weeks to write a paper on a topic of my choice that will be a learning experience for me and possibly a document that my school could use to help medical students as they start their clinical rotations.

My topic = The most common chief complaints (CC) at emergency departments and the differential diagnosis (DDx) for these ailments. While researching this topic it was easy to see what I already knew that if you approach it from the "most common" you quickly see that the most common are not necessarily what an Emergency Physician needs to master. Many of the most common complaints / presenting patients to the ED are not true emergencies but rather primary care type chief complaints and they seem to always occur at 3:00 am.

For example. At 3:00 am on one shift a patient comes in and says hey I am constipated. After examine the patient and doing a thorough physical exam and realize that this is not an emergency. He had been battling with the constipation on and off for 6 months but for some reason at 3:00 am on this thursday night he decided it had become an emergency. He did have a good case of constipation but no primary care physician and did not have insurance. He was intoxicated and rather belligerent. So I decided that I take care of the patient. Ultimately after some enemas I digitally disimpacted the harden fecal mater in his bowel and this relieved his issues. I started him on a regimen and treatment plan to improve his diet and cut back on the drinking and smoking and sent the happy patient on his way. Not really an emergency. It could have possibly developed into an emergency but when I saw him at 3:00 am it was not an emergency.

I decided to change the topic of my paper the 10 most important chief complaints in the emergency department and the to DDx for each. One would be a chief complaint of chest pain and I wrote out in detail all the possible different diagnosis that it could be and how you would narrow it down to make an accurate diagnosis. Just to name a few it could be a myocardial infarction, pneumothorax, pneumonia, fractured rib / flail chest, mallory-weis tear, pancreatitis and etc, etc the list goes on and on. No need to bore you here.

Part of being a good / great emergency physician is being able to quickly and accurately diagnose and treat many different life threatening illnesses. However you get your fair share of non-emergant pathologies as well and you have to be able to manage these illnesses and manage all the different colorful personalities that may show up on a given night. No one said it was not interesting and I happen to love the chaos and the never ending unbelievable stories that show up as patients to be treated and helped to heal. There is a saying in medicine that says Emergency Doctors always have the best stories to share at social gatherings.

I have to finish up this project this week and then I start a month long rotation doing internal medicine at a VA hospital. Government medicine at its finest. I will have some great stories for sure so you may want to stay tuned.

Age of the younger Tox Patients

There is a general rule regarding toxicology patients. Generally fro age 0 - 3 we see lots of accidental exposures to toxic substances. This is the toddler that gets his / her hands on mom's or grandpa's medications and gobbles them down or the kid that drinks bleach or some other substance. These are usually accidental exposures.

Children at the ages 4 or 5 - 12 this is a relatively a calm period for accidental exposures or intentional poisonings. Any of exposures in this age group the physician must consider medical conditions that require medications and possible interactions of the medications or too much of a given medication or possibly child abuse, either by neglect or by munchausen by proxy.

Children at ages from 12 or 13 and older and above have toxic exposures by suicide attempts or accidental overdoses in drug abuse. Teens start experimenting with drugs at these ages and also some teens attempt suicide by pills. The physician has to be aware of these trends and make sure to fully investigate all of these possibilities when the patient presents to the emergency department.

This is toxicology!