I was talking to a friend of mine, Dr Nawaz who has Internal Medicine and dermatology practice in Wesley Chapel,
. He raised a very good point the other day. He said a good doctor is skeptical; he raises questions, even for common problems. And that…..defines a good practitioner. Florida
He gave a very good example, he saw a patient who has been complaining of ear pain for some time. He was seen by various doctors and eventually was diagnosed with an ear infection. He was treated with antibiotics and what not. Patient finally came to him and he saw this patient in the clinic. His examination was not consistent with an ear infection. He ordered CT brain and found out that patient had a brain mass.
His point was that you have to ask questions even for your everyday problems. Every GI bleed is not due to an ulcer, every sore throat is not pharangitis and every chest pain is not because of a heart attack. I am not trying to say that you should order a brain CT for every earache, however, when we see a recurrent problem without any relief, you need to start asking questions fast.
As they say in medicine common things are common. You should not be looking for Zebra all the time, but you should know when you need to take your binoculars out. There is an unsaid rule in the ER, if you have recently discharged a patient from the ER without admission and if he comes back soon with the same problem, you got to admit him. Even if conventional wisdom says otherwise. We as hospitalist usually try not give them any grief when they call us for those admissions.
So the bottom line is that you should be ready to think outside the box, and more importantly you should know when too.