July 18, 2008

• A proud moment.

  For the first time today, i came up with a plan all by myself.

  Normally before we round, I will get a chance to at least run my history and physical by the fellow and discuss the plan i have come up with. This will be followed by a discussion of “yes thats good, or no do this and here is our justification for it” type of dialogue

  But today our consult service was swamped with more patients than we could take care of before rounding, so when the time came for me to present to the attending, I was in the hot seat flying solo. And I made my way through it. I went over the H and P, the lab values, all the usual things with little to no commentary by the attending asking for more information, since i was providing all the necessary data.

  Then when he asked me what i wanted to do, I had both a differential ready and a plan.

  “Well, given his active bleed and previous history of gastric AV malformations, I would like to do both an EGD and a colonoscopy.”

  Fairly simple, right? Well, at least in the context of most people being consulted to GI get one or the other. But that is beside the point. For the first time, I was the one who decided it should be done, and I justified it. And the attending agreed with me. given the symptoms i described, he said it was a reasonable plan. Then when rounds was over and we moved on to staffing the patients, the fellow was confirming with me that my patient was on the list for colonoscopy for tomorrow. I told her, EGD too unless she didnt think it was necessary…still nursing that bit of doubt, i guess.

  All she had to reply was, well its your plan, just make sure you notify the primary team so he can be prepped.

  No one argued, or corrected, or even made a teaching point out of it. I saw the patient, and based on my evaluation, and my evaluation alone, he is going to have these procedures done.

  Now THATS validation.

  • 1:56 am
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