Tuesday Morning Quarterback

Coming up on my 6 month anniversary at my new job, I've realized that I am slowly but surely gaining confidence in my clinical judgement. Here's how I know. Last night I admitted a child with a complaint of limping and leg pain. The story was suspicious for infection, hence the reason for admission. However, when the residents examined him his pain was gone and he was well and playing. He's already admitted at this point, it's late at night, and the seed has been planted that this child may have a bone or joint infection that needs to be evaluated. So, I did what any self respecting physician would do. Nothing. I am a firm believer in these two ideas:

1. Don't just do something, stand there.

2. A child will declare themselves when the time is right.

I figured I'd give the child the benefit of observation overnight knowing that time would tell me what I needed to know...whether or not I should pursue a workup. I explained that to the daytime hospitalist this morning, feeling a little bit silly in the light of day that I admitted a child and then did nothing, but she seemed to understand and agree.

I ran into her at the end of the day and asked about the boy. Turns out, he remained well and did not have any leg pain throughout the day so she sent him home. Here's the rub. His labs suggested a high level of inflammation going on but that did not fit the way he looked. This brings me to a third idea I hold dear.

3. Treat the patient, not the lab values.

Unfortunately for her, another physician heard about the case and clearly does not believe in the three ideas I've listed above because he felt that more should have been done and that the child was sent home in error. Despite the fact that he looked like a peach from the minute he arrived on the floor. Then this other physician asked the dreaded "Who staffed this patient last night?!" Now, 6 months ago had I heard this story I would have turned red, my stomach would have dropped and I would not have been able to let that comment go without picking it apart, losing sleep and berating myself for missing something. But today, 6 months later? I just thought, "Huh. That's funny." And let it go. I will not lose sleep over this tonight. I will not let his Tuesday morning quarterbacking make me feel less than. And I will continue to practice by those 3 ideas, because that is what I feel is best for my patients. And I am their doctor.