Today I am week 3 into my internal medicine rotation. Our clinical teaching team just switched attending physicians. The internal medicine physician I worked with today called me over, and told me he had a good Emergency Consultation. My case:
78 year old male with history of hypertension, diabetes, renal transplant after 15 years of dialysis, severe peripheral vascular disease and gangrene of the toes, past coronary artery disease presented with 3 second periods of light-headedness which started this morning at 8:30 AM when he sat down to read the paper. This occurred six times. The paramedics found atrial fibrillation on ECG at 10:30 AM while on route to hospital. Pt has had no other symptoms other than the lightheadedness. Patient denies chest pain, shortness of breath, altered level of consciousness or mental state. Physical findings were unremarkable, however cardio exam revealed a 4th heart sound. All investigations came back normal (bloodwork, Troponin T, CK, glucose, etc.).
He told me, “this would be a good case for you, I have lots of clinical pearls to teach.”. I saw the patient on my own, wrote up my consultation note, and reviewed the case once I was ready. He listened to me as I listed what I gathered from the history and physical, investigations, as well as my assessment of the situation and plan.
“Talk me through the common causes of Atrial Fibrillation”
“What do we worry about for management of New-Onset Atrial Fibrillation?”
“What drugs would we use?”
After each point, he gave me feedback. He wasn’t condescending towards me as I expressed that I didn’t know the answer to some of his questions. He even sat down and walked me through how to read this gentleman’s ECG. Afterwards, he thanked me and acknowledged my contributions for this patient’s care at the hospital under the Internal Medicine unit.
I walked away, feeling like I had learned so much. I appreciated his patience, his time, and acknowledged the fact that medicine is not something I can learn entirely on my own.
What an end to a great day.