I've noticed my Attendings pushing me on the oxymoron that is the practice of medicine. They ask me, "Are you sure?" The truth... there is never anything 100% in medicine. I've seen it time and time again, there is no guarantee. I know it. They know it. They know that I know it, and I know, that they know, that I know it. So really, it's a test. After glancing at a chest xray for 5seconds, was that enough time for me to weigh the risk that I missed something, and despite that, make a decision about patient management. Yes. The answer is yes. In my opinion, indecisiveness and/or fear to make a decision due to the plethora of reasons readily available in medicine, is often the more dangerous option. For everyone involved, from the patient, to the nurse, to the family member. So practicing what I preach, when the patient, filled with bullet holes, looks at me en route to the operating room, and asks if he is going to die. I say no. No sir, not on my watch. We got you! You're going to be just fine. I don't just say it once, I say it multiple times, in many different ways. The patient needs to be on board with this plan, and if my decisiveness will help him feel that then, Yes, I am sure!
I recognize, that as a resident it is still exponentially easier for me to have this opinion, then when I will move into the position of attending and become ultimately responsible for such decisions. Hence, why I make a point to exercise my decision making practices as much as possible now before entering into that different tier of responsibility.
On the otherhand, I also recognize that as a resident, I am allowed a certain level of leeway on my knowledge, and from time to time am still allowed to say, "I don't know." I used that unspoken margin of freedom the other day. Was working with my attending through an angiogram, and we quickly identified our patient's problem. Looking at the details of our patient's blockage, my attending made a decision based on a potential complication that he could see happening should we be successful at clearing this particular blockage. To prevent such a complication required the use of a very specific catheter, one which I have never used before myself. I watched, rather uselessly, as my attending attempted to assemble the catheter. Unsuccessful in his attempts, I could see the gears spinning through the options in his mind. Should we just proceed without the specific catheter, it is just a possible complication afterall. No guarantee it will happen. I finally played the resident card, leaning in so only my attending could hear me (the patient was awake for the procedure), I asked if he'd like me to break scrub and youtube a video. He thought a second longer, pausing, before dropping his head and nodding. Sure enough, there is an excellent instruction video on youtube, through which we were able to identify our mistake in the catheter assembly. The procedure went by successfully, and sure enough, my attending had been right. That special catheter prevented a potentially devastating complication from happening. My attending, heartily thanked me for looking up the youtube video, his relief almost causing him to be emotional.
At the end of the day, medicine keeps me learning, keeps me humble. It is the great equalizer. Even while answering, Yes, I am sure, a part of me judges myself for such a lie.
Much Love and Prayers.
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