Let's check everything!

Where I work there actually a few "fresh" docs who do a very focused, "custom build" workup for pts. I like it b/c it saves time, but I keep saying - they practice like s/o who's never been sued...

Maybe we work at the same place? I've noticed it's completely dependent on the attending. I think everyone gets a slightly more comprehensive work up for the learning experience? Our frequent flyers though are probably the on,y ones who don't get extensive work ups...

...and depending on the provider, sometimes the frequent flyers get the full work up anyway. For the same complaint they've had for the last three years.

Isn't it ironic though, that it seems to work this way...

Pt x comes in with vague complaints. They don't get a work up. Give em some po meds and watch em. They feel better and go home.

3 days later, they return, get a full work up and bam, they are being transferred for a sub dural bleed.

...and depending on the provider, sometimes the frequent flyers get the full work up anyway. For the same complaint they've had for the last three years.

And THEN the FFs wonder why the last doctor did all this testing and the current doctor must not know anything because they aren't DOING anything for said FF, who also, by the way, thinks this hospital SUCKS. :)

This can be a symptom of newattendingitis, as they adjust to the reality that "this is really all on me now" and feel the weight of the world on their shoulders.

Of course, some continue to practice that way throughout their careers ...

Ah yes, the good ol' shotgun workup! One of the reasons I really like working with grey hairs. They rely on their H&P to guide their differential diagnosis, rather than just taking a stab at everything.

They rely on their H&P to guide their differential diagnosis, rather than just taking a stab at everything.

I guess it's sorta like a student nurse using a doctor's medical dx. to "make" their nursing diagnoses.

Of course, some continue to practice that way throughout their careers ...

Ugh, tell me about it.

I think some of it falls on patient satisfaction scores too. More likely to get a higher rating if the patient felt like ever avenue was addressed. Then again CYA seems to take the cake.

I used to work with a doc that would first order every lab possible for almost any complaint and then order rocephin, reglan, torodol, NS bolus, and sometimes a few additional meds (gi-cocktail, zofran). Then after all the labs were back and nothing showed up he would go into the pts room and tell them "Well its difficulty to pin down exactly what you have but I have given you an antibiotic that treats almost anything, an anti-inflammatory to treat any inflammation...." so basically there was no large arrow directly pointing to what the problem was so just treat the patient for everything.

Drove me nuts to work with him..... but the patients were always happy and hardly ever came back.