By Eric Warm M.D.
I’ve often wondered what would happen if interns had sportscasters.
It might sound something like this:
DAVE: Well Bob, the intern is about to start another call night. Last time he had six completions, but he got behind, and had to play catch up all night long.
BOB: He’s a rookie. That happens.
DAVE: Yes, but his senior resident was not happy.
BOB: She’s a tough one.
DAVE: Here comes the intern now, about to see his first patient. His hand washing rate is 0.868 – not bad, but not where it should be. He’s reaching for the gel now. That’s a good sign…and there’s a double pump!
BOB: Wow, is that a personal foul right off the bat? We need to see the replay – I’m not sure he got any gel onto his hand.
DAVE: That can’t happen. Hand washing isn’t just for show.
BOB: You’re right Dave – if the second pump was dry he really should remove the empty container, notify the nurse, and get a new one. The best interns would do that. Here’s the replay, and… yes! You can see it right there, the telltale glisten of dispensed gel. He did in fact disinfect his hands. That’ll raise his average to 0.870 for the year.
DAVE: He’s approaching the patient now. In the past he had trouble with his footwork. Oh no -- he’s gone to the left side of the bed!
BOB: That’s because there’s a tray on the right side, Dave.
DAVE: I know, but he could move it. How’s he going to examine the patient from the left side?
BOB: You’re correct. You really can’t feel the spleen from the left.
DAVE: Let’s see how he handles it. Maybe he’s only taking the history. Here comes his first question.
INTERN: Are you having chest pain right now?
DAVE: Classic rookie mistake! Starting with a close-ended question.
BOB: Maybe he’s thinking about how far behind he got on his last call night, and he’s just getting right to it tonight. Or, it’s possible his senior resident told him the guy was having chest pain, and he’s just making sure there’s nothing going on now.
PATIENT: No, I’m not having chest pain now.
INTERN: Good. Can you tell me what brought you here tonight?
DAVE: Great pivot by the intern – now moving towards open ended questions.
BOB: When I was an intern I used to ask the ‘what brought you here tonight’ question until one patient said “an ambulance” and I laughed so hard they reported me to the chief of staff.
DAVE: Good story Bob. He’s taking a social history now. Let’s listen in.
INTERN: Are you sexually active?
DAVE: Really poor form there. He should have been more detailed with the question.
BOB: I’m not sure about that. The patient is having chest pain, what does a sexual history add?
DAVE: He might need Viagra someday. What if he takes nitrates after this hospital stay?
BOB: That’s attending level, Dave.
DAVE: Someday this intern is going to be in the big leagues. You should practice how you play. Looks like he is done with the history, now he’s doing the exam. He’s moving to the right side.
BOB: He’s actually quite skilled in tray-table moving. He was able to shift it to the head of the bed without spilling the ridiculously overfilled water container, and he didn’t knock the phone off. Really high level stuff there.
DAVE: He’s listening to the heart using a Littman Cardiology IV stethoscope. Dual headed with both bell and diaphragm. It’s adequate. However, this patient is in the Emergency Department, and it’s loud in here. Maybe he should have chosen the Littman 3M 3200 Noise Reduction model.
BOB: He’s on small market team – they can’t afford something like that.
DAVE: We know this patient has a soft systolic ejection murmur, and an S4. Let’s see if he hears it.
PATIENT: Do you hear anything doc?
INTERN: Sounds normal to me.
DAVE: He should have gone with the 3200.
BOB: It’s a poor player who blames his tools.
DAVE: Right you are there, Bob.
BOB: The senior resident is motioning for the intern to step out. She doesn’t look happy.
DAVE: They’re having a heated discussion about something – looks like a cross cover issue. I’m not a lip reader, but I think she just asked him if he knows sick from not sick. He looks crushed.
BOB: He’s getting paid a lot to do his job. When I was an intern we got paid half has much, and had half the protections! I think tough love from the senior resident is just what he needs.
DAVE: I don’t think that’s love, Bob.
BOB: Oh, did you see that? The patient put his hand over the left side of his chest. He’s leaning forward. Classic Levine sign. Will anybody recognize it?
DAVE: The intern is still arguing with the senior resident, but…I think he does see it. He’ making his way back to the patient. Single pump on the gel. 0.872.
INTERN: Are you having chest pain right now?
INTERN: Let’s get an EKG.
DAVE: This is a critical moment! He’s made the right first move. Ordering an EKG is one thing – but can he read it?
BOB: Last week he thought a rhythm strip had atrial fibrillation, but the patient was just cold and shivering. He almost started anticoagulation!
DAVE: That’ll do a number on your confidence. Let’s see if he can get this one right.
[EKG appears on screen]
BOB (using telestrater): What you’ve got here is an inferior STEMI – really subtle ST elevation in the II/III, and AVF, but definitely there.
DAVE: He’s studying the EKG.
INTERN: Sir, you appear to be having a heart attack. I am calling the cardiologist now.
BOB: Great pick-up by the intern! I guess he does know sick from not sick!
DAVE: Do you think he should say that to the senior resident?
BOB: We didn’t do that in my day, Dave.
DAVE: I thought you said times have changed.
BOB: Some things are not affected by time.
DAVE Right you are! We’re going to take a commercial break, and when we come back we’ll see what happened in the cath lab, and whether or not the intern ordered the antiplatelets just like the cardiologist wants. Back after these messages from beer, processed meat, and fried things.