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.)

Older

Newer

Annals of Bad Housekeeping: Bathroom Edition

1st Folio: Dear Husband and I adopted a cat from the humane society a month ago (introductory post with photos coming soon!). She spent most of her first week hiding in our semi-finished basement, either behind some boxes or up in the rafters. One of the first clues that she had ventured to the first floor of the house was these dirty paw prints on the 1/2-bath sink, presumably leading to the fragrant bar of lavender soap. I thought our furry friends were supposed to leave paw prints on our hearts, not our porcelain fixtures.

2nd Folio: The upstairs bathtub faucet has dripped since we moved in two years ago. We immediately asked the landlord to send a plumber, who pronounced the situation hopeless, since the pipes are encased in the wall. About a month ago I decided to try to measure how much water was coming out of the faucet: about 2 gallons per day! I have tried to capture the water and re-use it around the house: in the Brita filter, for washing produce, and especially for watering the plants. Unfortunately, the aloe plant took offense to suddenly living in a tropical jungle rather than in an arid desert of benign neglect and promptly rotted at the stem.

What Residency Looks Like XXIX: Family

Since before we started residency, it's been rare to get all four of us in my cohort together in one place at one time. Thanks to J.P., M.K., and J.T. for humoring me in taking this cheesy "family portrait" in the ENT conference room after a lecture about mechanical ventilation. We may look like mater and pater familias with two spunky daughters, but we function more like cousins who value all the time we can steal to spend together.

Older

Newer

What Residency Looks Like XXVIII: Dirty Scrubs

Sometimes residency looks like starting your Emergency Department shift with pre-splattered scrubs. Is it blood? sh**? No, it's chocolate ice cream I tried to eat in the car on the way to the hospital on a hot day. Lesson (probably) learned.

Older

Newer

What Residency Looks Like XXVII: Breakfast of Champions

Sometimes residency looks like chocolate ice cream before your night shift.

Older

Newer

What Residency Looks Like XXVI: Trees of Green, Skies of Blue

Sometimes your attending lets you out early, and even though it takes 45 minutes to drive home, there is still warm sunshine outside. So you and Dear Husband change into shorts to walk to the ice cream store to fortify yourselves for the descent into Frick Park to lie on the grass in the shade and study nephrology or read about Mozart.

Older

Newer

What Residency Looks Like XXV: Sunshine on a Cloudy Day

Sometimes residency looks like a bit of sun on the sculpture garden at the hospice center in the middle of a rainy day, when your attending lets you out early, and you decide to spend the afternoon adopting a cat (pics when she gets brave enough to come out of the basement!).

Older

Newer