16 September 2013

Falling on my sword

Before team rounds, I went over the patient list with my resident. One patient was still sick and was not improving. "Bummer," I said, "I guess we're going to have to keep Patient X for a few more days."

"No," the resident replied. "He's to be discharged today or tomorrow."

"You really think so? He looks pretty bad."


"So what's my argument to the team? He's not going to improve any further, so there's not any reason for further hospitalization?"


My cheeks felt flushed. This patient was not ready to go home. This was going to be a disaster. But we are often told that our job as medical student is, above all, to make our resident look good. I would get in even more trouble if I contradicted the resident's plan.

During rounds I presented the patient to the team. The clinical findings I recounted couldn't mask the fact that the patient was in bad shape. Then I arrived at the portion where I present my assessment and plan: "My opinion is that the patient is ready for discharge because we cannot expect further improvement from continued hospitalization."

The attending physician (the head of our team) disagreed and started questioning me aggressively. What did I mean the patient wouldn't improve? Had I allowed enough time for the medications take effect? How could I send a patient out who's in such a condition? I didn't want to argue. The attending was right.

I looked pleadingly at my resident. Please help? The resident sat stone-faced and didn't say a word. I was on my own.

I didn't have an answer to the attending's questions. I grimly shook my head. "My mistake," I said. "We'll keep the patient for at least a few days and see how he does."