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21st June 2007

hubris

posted in Uncategorized |

I am 9 days from completing my internship, the first year of my residency. After this, it will be me in charge of the interns, directing the team, and helping the fresh-faced, confused recently-made-doctors in taking care of our patients, making sure that nothing is overlooked, that we consider everything that could be potentially causing our patients symptoms and that it gets worked up properly. A whole new level of responsibility. Instead of 5-10 patients, I’ll be responsible for knowing about 15-20. It’s the next step to becoming a Real Boy independent physician. I know that I have areas of weakness (still hate EKGs, still hate drugs), but overall, I think I’m doing pretty good. I’ve even gotten praise from my attendings and residents in reviews, stating that I’m performing above the level that I should be. Maybe I let some of that go to my head…

I missed the diagnosis of an aortic dissection yesterday. Completely and totally missed it. Granted, my patient didn’t come in complaining of the classic symptoms and we thought we had the reason for the other chief complaints–once we got the blood pressure controlled, the headache disappeared and the abdominal pain was gone as well. I was ready to discharge, had all of the paper work ready and was rather upset at my attending for wanting to get an echo, and then a CT scan on a patient who already had a reason for a murmur and was doing fine. Eating, breathing, walking, with no complaints. But there’s a reason for the hierarchy, and I got the scan without too much arguing (just a lot of internal grumbling).

Even then, I missed it. I looked at the scan yesterday morning, saw a little fluid at the lung bases and that was it. I completely missed the large bulge in the aorta, as the blood leaked out. I didn’t get it, until the radiologist called and informed me what the pictures really showed.

Aortic dissections are deadly. They can rupture, causing instantaneous, massive blood loss. In medical school, it is one of the “red sign” diseases that are always top on the differential, as they are the worst case scenario.

And I missed it.

This entry was posted on Thursday, June 21st, 2007 at 5:58 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

2 Comments

  • That’s why you’re there though – to learn from the other doctors and to learn from your mistakes. The important thing is that it was caught – and I know in the future you’ll be examining those scans carefully. All doctors miss something now and then. As much as we’d like to think they’re the be-all and end-all of our health, they are just human.

    You said it yourself, you’re doing a really good job. And I, for one, am proud of you. You’ll continue to learn and grow, and you’ll be a truly wonderful physician someday.

    -hugs-


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    stephantasy@livejournal says:

    *hugs*

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