One of those days

Today I was gently reminded of a lesson I should have known better.

"Ultimately, this is your patient," Dr. M told me.

Too true.

This afternoon's events left me feeling so mad at myself. And so totally stupid.

I had seen a patient with hypercalcemia, high-normal PTH and osteoporosis last month. Perhaps primary hyperparathyroidism? I had wanted to obtain some confirmatory tests. But my boss that day said No. We have all we need. Just get a sestamibi.

I didn't quite agree, and had suggested some other tests, but he just brushed me off. After all, this was a 60-year old consultant with decades of experience, and I was a 2-month-old clinical fellow, so who was I to argue?

Well, as it so happens, her parathyroid scan showed a ditzel in her left lower pole of the thyroid.

"Just a hint" the nuclear radiologist told me. He didn't see it on the Iodine-123 or sestamibi subtraction images, but on the SPECT.

And so my boss made me get the surgeons involved. While I had this nagging doubt. After all, she was in her 70's. And her T-score wasn't all that bad.

They came by today. Wasn't impressed at all by her numbers. And as it turns out, I had a different boss today, who felt we did a sloppy job clinching the diagnosis in the first place. And I had to agree. It was as sloppy as sloppy went.

He realized the scenario after reading my other boss' notes. And gently added his words of wisdom:

"It may be your consultants who are in-charge. But ultimately, it's your patient. If believe something isn't being done right, you need to say something. Because ultimately, you will have to defend your stand and your actions or inactions."

And true as it was, I wasn't able to defend myself today, except with lame, "My boss made me do it."

We learn on the job. But really, I hate days like this.