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When Instinct Trumps Expertise

A hard thing about being an ER doctor is that I know a little, sometimes very little, about a lot of things. When I am faced with a particular condition, I often need to call the specialist for that organ, who knows way way more about it than I ever will, and they all think I’m an idiot because I don’t know as much about their organ as they do. There’s a huge asymmetry of knowledge, and it can create some tension and conflict.

I’m OK with it, because I can ignore their condescension and I am secure with what I do know, and its limits. But sometimes I get perplexing instructions from the specialists. The emergency medicine dogma can be overbroad and a little hidebound and what the specialists will do in the real world often radically diverges from what the Emergency Medicine textbooks say to do. It’s often an interesting learning opportunity for me, especially when it’s a condition I don’t encounter that much.  But I also have to work to maintain a flexible and open-minded attitude when I call a consultant and my side of the conversation consists of “Really? I didn’t know you did that for this…” You need to know and trust your colleagues in other specialties, and know when to call BS on them and push to do something else, which is really hard to do when you are talking to someone who is so much more of an expert than you are.

So I saw this guy recently, an urban hipster who was perhaps a bit too old to be riding his longboard on the hilly streets of our fair town. He didn’t seem to be too good at it, judging by the collection of crusted abrasions and aging ecchymoses he was sporting. He had been falling a lot recently — we only get about a month of sun here, so I guess he was making the most of the summer weather practicing his new hobby.  He had a variety of complaints from Read more »

*This blog post was originally published at Movin' Meat*

Gratuitous and grisly x-ray images

A bizarrely morbid slide show of radiology images showing various patients impaled by foreign objects.

If you need more reasons to be wary of nail guns, fishing spears, keys, or knives, look no further.

knife x-ray

harpoon xray

keys in eye

nailgun xray

*This blog post was originally published at*

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