Callous Callosotomy: November 2009

November 05, 2009

Heard Around Town

I heard two things yesterday from attendings that I found distressing for different reasons, and thought I'd post here for posterity and comment.

Scene 1: Five MSIIs in an exam room with an attending and a patient. Attending doesn't say a single word to Pt or introduce himself. After 15 minutes of didactic discussion in the exam room with patient sans gown, we're each given 90 seconds to perform a cardiac exam. I'm first up to bat, so as I'm fumbling around for a radial pulse, I shake his hand, introduce myself, ask the patient's name, and ask how he's feeling today. Verbatim from the "old codger" (his words, not mine) attending: "You can talk all you like, but you just wasted 10 seconds of your exam time." Good point--there's really no medical reason to communicate with Pts; it's no doubt a sign of weakness to elicit hints of what to look for on physical exam by attempting to take a history. Great teaching point, sir. Thank you.

Scene 2: Four med students in anatomy lab quizzing each other on shoulder musculature while the attending helps tidy up our dissection. Student one: "What action does the deltoid perform?" Student two: "A-B-duction, with the supraspinatus providing the first 15 degrees of movement and deltoid taking over thereafter." Attending: "Yeah, that's what your textbook says and what you should learn for this class....but it's kind of a lie." [Consternation and grumbling amongst students] Attending: "You know, it's kind of like kids and Christmas: everyone starts out believing in Santa because everyone older perpetuates the myth, and then we let you down gently when you're ready." (Med student 3: "Wait, you mean there's no Santa?!") *sigh* I've known this was true since last year (not so much let down gently by Dr. Papa and Dr. Momma Bear, FYI), but hearing it admitted as a pedagogical institution is nevertheless a bit disconcerting. If I'm gonna bust my butt this hard to learn all of this, it'd be nice if at least most of it were true (and if Santa and Rudolph could make a cameo at my house this year).