I was at my last day of my GP placement yesterday, and i took an observed history of a patient with atrial fibrillation.
I asked about his palpitations, he told me how he feels odd irregular beats across his chest, and with all that in mind, i then did a cardiovascular exam, and what seems logical went out of my head..
i just went with my "routine" comment, feeling for the pulse and commenting: "the pulse is of sinus rhythm, regular, HR within normal ranges, symmetrical on both arms, there is no radial-radial delay.." this was when the Dr looked very worried and stopped me...
"Tofu... are u sure?! this man has AF!"
.. this was when i snapped out of my stupid routine and realised how stupid i was! i was almost day dreaming, and just repeating a routine... so so so stupid >.<
AF - is irregularly irregular! i should have known that from the history alone!
This was embarrassingly stupid, but in a way im glad it happened in hindsight. It annoys me how silly it was, but i guess it's a good time for me to realise i need to REALLY pay attention to things... to look, listen and feel for signs.. and not just assume patients are "normal".
I will take it as a learning experience.. going to never do that again!
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Okay.. it's now croissant and coffee time, then off to my ward! (with a more serious approach to clinical examinations, no more relying on my safety routine comments!!)
5 comments:
Hey, don't beat yourself up about it...we've all had brain vacuum moments before, hell I have them everytime I'm in the lab :( However, I know that you'll learn from this...perhaps a bit emabarrassing but at least you'll remember for next time!
ha! this is what the real osce is like though, you can tell from the start whether the patient is going to have signs (i.e. are they a student who just wants some extra money, or an elderly lady who wants some extra money), if not then regurgitate away!
A cheeky trick you can use in patients who complain of an irregular heart rate is getting them to tap it out on the desk for you.
Makes you look so slick.
Grumpy:
Thanks grumpy, it was so so embarrasing, but defo have learnt from it.. i've been so vigilient with the pulse now!! And brain vacuum... hmmm i think mines in a constant vacuumed state lately :P
Anon:
Thanks for the pointer! I think they're slowly going to roll out real patients for us this year... don't think im going to be able to get away with regurgitating my lines.. like i did for year 1 and 2 >.< just have to break the habit!
ASD:
Oooh, never heard of that before, i have a cardioresp firm next, so will try that one out!! Thanks for the pointer ^^!
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