The "handbook"

As an intern you’re constantly reminded of how dumb you are. No matter how much you read about a particular patient’s disease, on rounds the attending will most certainly ask you the *one* question you don’t know the answer to.

“This is Ms. Sanchez, she’s a 21 year old Hispanic female who presented to the ED last night complaining of right upper quadrant abdominal pain. This is the second such episode…”

Attending interrupts my perfect, well-rehearsed presentation “so what is your differential diagnosis?”

Huh? What about the rest of the history? Don’t you want to hear my very focused physical exam? And there are lab results to report. I worked *all night* preparing this damn presentation, and he wants to skip all the way down to the differential?

After reciting my (memorized) list of possible diagnoses, he decides to pimp us. I think it made him feel special to demonstrate in front of a group how much more he knows than the rest of us. After a 30 minute discussion, we agree that the patient probably has gallstones. I’m now feeling quite proud, ahead of the game, because I stayed up *all night* reading about cholelithiasis (gallstones) and can basically recite everything there is to know about this disease. I’m gonna show all my fellow interns that I’m smart, that I know my stuff.

“So, Dr. Gilman…,” (bring it on) “can you tell me the name of the person who had the world’s first gallstone?” the attending asks.

What?! You’ve got to be kidding me. Who knows the answer to that, and why is it relevant?

I stare back blankly.

“Anyone?....This is a very basic question. You guys should know this. You call yourselves doctors? How are you gonna effectively treat this disease if you don’t know basic information about the disease?”

Of course there’s some goody-two-shoes intern that actually *does* know the answer…and I end up looking like an ass. On to the next patient (not mine). As were walking down the hall (interns behind the residents, but in front of the medical students) my resident slows down a bit and whispers to me “I should have told you that, he *always* asks the interns that question on rounds.”

Note to self: get a copy of the ‘what the attendings love to ask interns’ handbook. All the reading I did, and all of the *relevant* information I learned went unrecognized because I didn’t have a copy of that handbook.

I was to discover that there were many “handbooks” during residency. Some were more important to have than others.

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