What Residency Looks Like XXX: Diagnostic Referral Codes

I have just completed a month-long rotation in the Emergency Department (pro tip: no one in medicine calls it the ER) at an urban, academic, tertiary-care center. I didn't see any traumas--the surgeons ran those. I saw some real emergencies--like heart attacks and strokes--but the attendings actually ran those. Most of what I did was basic primary care medicine. In fact, it reminded me of a joke on a Twitter thread by @GruntDoc, responding to the prompt, "Anger your entire speciality in one sentence":

(Walks up to podium at major Emergency Medicine conference)
(Taps mic)
Me: Really we’re all just glorified Family Practitioners with a CT scanner.
(Beaten to death with personally owned handheld sono probes)*

As a way to try to grasp what I actually did that whole month I was in the ED, I decided to tabulate the different kinds of problems I saw during one warm-weather month. The numbers don't add up to the total number of patients seen at the bottom, because some had multiple complaints. If my math is correct (and I'm not sure it is), then I admitted just over 1/3 of the patients I screened in the ED to the hospital.

heart attack  1
low blood pressure  4
high blood pressure  2
low heart rate 1
high heart rate  2

breathing problem  2
community acquired pneumonia  1
aspiration pneumonia  1
needs lung transplant  1
post lung transplant  1
pleural effusion  1

abdominal pain  3 (1 of these turned out later to be cancer)
nausea/vomiting  4
acute diarrhea  1 (probably typhoid acquired abroad)
chronic diarrhea 1
constipation  2
acute pancreatitis  2
perforated viscus  1
pooping blood  1
rectal prolapse  1
diverticulitis  1
proctitis  1

Lyme Disease 1
viral syndrome 2

Practicing foreign body removal.

strep throat  1
Sickle Cell pain crisis  2

allergies/allergic reaction  4
low blood sugar  4
high blood sugar  3
hepatic encephalopathy  1
medical problem unspecified  4

fluid overload  2
UTI  4
peeing blood  1

bloody nose  1
rash  2
cut  2
beaten up  1
burst varicose vein  1
accidental needlestick/blood exposure  2
dental abscess  3
other abscess  4
kicked in the chest  1
muscle strain  2
tendon sprain  4
broken bone  4 (femur, finger, skull, lumbar vertebra)
post-surgical complications  4
arterial thrombus  1

headache (migraine, IIH, post-LP)  3
VP shunt malfunction  1
head bleed  2
seizure  2
seizure-like event  1
pseudoseizure  1
stroke  1
near syncope  2
fall  4
spinal cord compression  1
unknown neurological condition  2
   (1 turned out later to have Creutzfeldt-Jakob Disease)
whiplash  1
pain  12
sciatica  1

psychosis  5
?panic attack/anxiety  2
accidental drug overdose  2
intentional drug overdose  3
alcohol or drug intoxication  5

corneal ulceration  4
conjunctival ulceration  1
subconjunctival hemorrhage  1
acute angle glaucoma  1
anterior uveitis  2
retinal hemorrhage  1
vitreous hemorrhage  1
optic disc edema  1
anisocoria  1


Procedures I did:
cardioversion  1.5
  (the second guy converted into normal sinus while my attending was consenting him)
opened an abscess  1
reduced a rectal prolapse  1
ocular lavage (I rinsed this guy's eye out)  1
suturing  0  (much to my dismay)


Patients admitted: 49/131



*My contribution to the Twitter prompt was this:

(Walks up to the podium at a major Internal Medicine-Pediatrics conference.)
(Taps mic.)
Me: It's true that MedsPeds docs are jills of all trades and mistresses of none.
(Cacophony of boos and jeers ensues.)

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