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.