Residing in the ER

I’m a pretty vigorous consumer of all thing #FOAMed.  But still most of my attendings aren’t.  There’s an odd generational thing I’m noticing.  Most people who grew up learning primarily from the old school of clinical learning won’t internalize to accept something as legit until they see one of their colleagues do it, or until it’s vetted through a more traditional mode, like in a class or in a review paper.  My generation is very willing to take things learned from online and incorporate it into our body of knowledge just be reading about it in a digital form.  It’s a completely different level of trust in how we accrue information.

It’s uncanny how often a clinical question will come up on shifts that is answered by social media without me even having to try to look for it, even without having to look for it actively.

Case in point.  Had a patient with a proximal first MC fx of his left thumb.  Rolando fracture?  Two days later someone re-Tweets a review on it. 

It’s absolutely incredible how much social medial has taught me.

Inspired by a co-resident’s tribulations:

If you place a consult and they give you a hard time about seeing the patient because it’s “an inappropriate use of resources”, then the only fair thing for them to recommend after seeing the patient is discharge without additional work up.

If they come back and ask you for MRIs, additional blood work, or to perform an LP or some other procedure, then their attitude was only thing that was inappropriate.

“pt was ‘doing the dougie’ and went down the wrong way and now has right knee pain on ambulation.  slight swelling.”

dispo: teach him how to dougie

“Brought in by ambulance from OSH.  4 days ago pt was attempting to assist an ailing baby squirrel that fel out of a tree.  squirrel clawed at her L leg, neck and shoulder, bit L hand, now with swelling of L thumb and index finger, got unasyn 3g IV, sent for hand eval.”

“A: …pt is sure that she has come to a place in her life where she can not take care of herself and needs to get housing in an environment where there is help.  She can no longer cope alone.

P: referred to ED.”