Let's check everything!

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Specializes in Emergency, Telemetry, Transplant.

OK, so this is kinda (mostly ;)) a rant. Some of our younger/newer attendings order everything. Like UA, all basic labs (with coags even if they are not on any anticoagulants), x-ray, and then a CT of something. Chest pain 2 years ago? CTA of the chest. 24 year old who fell 2 weeks ago and has had intermittent nausea since? CT head, even though the rest of the neuro exam is normal. 31 year old with burning on urination? No other symptoms. CT with contrast to r/o pyelo.

I understand its a CYA world, but why do when even need doctors? I can order every possible test that has something to do with that body part. At the very least, I could save the hospital money.

And now these young attendings are teaching residents that they need to order everything.

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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...

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Specializes in Emergency, Trauma, Critical Care.

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...

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Specializes in Med-Surg, Emergency, CEN.

...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.

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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.

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Specializes in ED, School Nurse.
...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. :)

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Specializes in Emergency & Trauma/Adult ICU.

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 ... :sniff:

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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.

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Specializes in Emergency, Telemetry, Transplant.
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.

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Specializes in Emergency, Telemetry, Transplant.
Of course, some continue to practice that way throughout their careers ... :sniff:

Ugh, tell me about it.

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Specializes in ER.

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.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

This, and then everyone gets a gm of Rocephin on top of it! We seriously almost ran out of Rocephin the other night. I am tempted to start writing that all the pts are allergic to Rocephin!!! Lol

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