Sunday, December 02, 2007

In The House

So, we have a new class this term. It's called "Clinical Decision-making." And it is AWESOME.

I am practicing (and hopefully, perfecting) the art of differential diagnosis. You know how on House, about 30 to 60% of any episode is sitting around and thinking about "what it might be?" That's what this class is. Naturally, I frickin' LOVE IT. (And yes, I have already whispered "it's lupus!" to the person sitting next to me.)

It's like being a Cheers fan, and having a class where you're asked to drink beer and insult each other. Or being into Miami Vice, and taking a course where you use the door of your Ferrari as cover in a gun battle where for some reason nobody's wearing socks.

The class happens each week, over a couple of days. On the day of the class, we have to write up our first impressions, and what our next steps would be. That night, the Web portal for the class shows us what the lab results and images and whatnot tell us. If we asked the right things, we can assume we now have those answers, and those go into a write-up that's due the next day. It's really fun, and exactly the kind of thing that I learn from. Back in EMT training, I killed one such hypothetical patient, and still remember those lessons. So far this term, no imaginary sick people have cacked it on my watch. Knock on wood.

So far, I have correctly recognized a Congestive Heart Failure case and a heart attack. Nice to know I can make 2 and 2 equal 4, I'd say. I was too conservative with the CHF'er, and wanted to wait for some labs to come back before getting some meds going. I was sure to say "STOP FUCKING SMOKING," though maybe not in those exact words. For the heart attack, it was presented a little cleverly, such that not everyone in the class saw it as what it was. My treatment plan was maybe a little too cute: it went, "1: CALL 911. 2. Do everything else in the ambulance and/or in the ER." I did go on and explain what 3-7 would be, but only grudgingly.

I also could have done more to treat the irritating chest pain the patient was suffering. Sorry, fake patient. Next time I'll give you some morphine for your ride in the fast boxy truck.

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