2scents – Some people never master it because they don’t care. I think there are books that are written on this -I think one is called “Sick /Not Sick”. I never read it though. I just think some people have a second sense when it comes to medicine – they learn how to read patients. I see a lot of practioners when they get called to a scene (EMS) or an ER for an emergency and the pt. is unconscious and then they go through ya know the ABC’s and go down the protocol -they think they are practicing medicine and are the best thing since sliced bread. I don’t consider this the practice of medicine.
This is what I consider practicing medicine and this story is Not meant to put down any type of practioner more than the next. I’ve seen lack of good care all across the spectrum. One of my rotations was in Geriatrics and I wanted something more challenging that just a regular Nursing Home floor. So I hooked up to the Vent floor. A lot of patients to say the least aren’t with it and they spend their life unconscious attached to a vent. The nurses do vitals I think 3 times a day. Now for these type of pts. the care can be very monotonous. As the student I got dumped with most of the routine paperwork. So I was doing the paperwork on this pt. and even though you do patient assessment on every pt. that you do this routine paperwork on – you basically don’t get any info. They don’t respond to anything and physical exam is usually Not Remakable. So I was holding by the putting down the vitals of this pt. and I asked the nurse for the vitals. The nurse gave me the notes and I noticed that she had recorded a slight fever. Since I don’t know the pts. I checked to see if this pt. has had fever before and this isn’t something new. But lo & behold this was a new onset -so I got the Resident and we did a septic workup. What I didn’t understand was why didn’t the nurse mention something to either me or to the Resident (it was usually a NP in charge of the floor but she was off that day)? Alerting the Staff to even a minute change is called practicing medicine. Watching s/o keel over and doing some protocol is just monkey skills!