paging MS3 to Sniffle Bay 1...
Spent yesterday in the pediatric ER. I had a great time. I was expecting 90% asthma exacerbations, and there was some of that, but there was actually really fun variety. My constitutional conflict with emergency medicine is that I am super conservative about both diagnostics and treatments. I’m a believer in both vis medicatrix naturae and primum non nocere, and think it’s fine to send people home with thoughtful teaching and reassurance.
There was only one doc on duty, and he was delightful. Not only did I just like him, but he basically let me run the joint for the day. He decided pretty quickly that he trusted my exam. He had me talk through my reasoning for my plans (usually “send them home”) in a way that was helpful, sometimes added some additional diagnostics which he acknowledged were for no specific reason and were probably not necessary, but generally just told me that I was right about everything and let me take care of the patients. Occasionally he’d stick his head in a room to tell the parents that I was great and their kids were in good hands, before whispering a wisecrack in my ear and then going back to doing whatever I had decided needed to be done. That, my friends, is the kind of attending who makes for a real good day. :D
The goal in the ER is to catch the actually sick kids, and I think I did a good job of that. One was obvious; a suicidal teenager with what I would describe as florid psychosis. I had her admitted. The other was a otherwise-healthy baby with vomiting overnight, to whom I might have been inclined to administer Future Dr. Weirdo’s Favorite Medicine (“go home”), exceeeept the vomiting was a bit on the projectile side and there was this subtle thickened spot in his upper abdomen. Plus Mom seemed really grounded, so I trusted her concern. I asked for an ultrasound (which the doc ordered without seeing the patient himself, because of his firm belief in both my awesomeness and, more importantly, in ordering too many tests on everybody because he’s an ER doc), and kiddo had an intussuception. Caught it early, he’ll be fine. Booyah.
I recognize that sending people home without performing diagnostics is just as serious a judgement call as deciding to order the tests. All of the tests that the doc ordered on the kids who I just would have sent home were normal. He thought they probably would be, but he has been BURNED before, and I get that. I’m in a weird spot in training where I don’t have enough experience to base decisions on fear, for better or for worse. It would have been really easy to mistakenly send that pukey kid home, and the other suicidal teenager who I didn’t want to admit…I am still worried about her. It’s tough.
But yeah, tldr: I always end up enjoying the ER.