Wrong Answers by Steven Colucciello, MD
Thursday, August 26, 2010 
Steven Colucciello, MDI was always good at standardized tests. It’s the real-life tests in the ED that I botch. Over the years I compiled a list of my “wrong answers”. See how well you do on the following questions.
1. A mother brings her 4 year old daughter to the ED with a small laceration on her forehead. She asks for a plastic surgeon. You respond;
A. “No way I’m calling plastics for this.”
B. “Ma’am, let’s be honest here; your daughter is really not that pretty.”
C. “You’re kidding, right?”
D. “We handle lacerations like this all the time; but if you want, I can call Plastics for you.”
2. You have just written an order to discharge a patient. The nurse comes to you and says, “Doctor, I don’t think this patient is well enough to go home.” You respond;
A. “and just where did you get your M Deity degree?”
B. “I’m in charge around here.”
C. “What part of ‘discharge’ do you not understand?”
D. “I’ll go back and take another look. What worries you about him?”
3. A patient comes to the ED with a history of various complaints all resulting in narcotic prescriptions. He asks for pain medication. You respond:
A. “Go home Junkie”.
B. “This is the 3rd time you’ve been here this month.”
C. “According to the controlled substances data bank someone must have stolen your identity and is traveling around the city getting narcotics at different emergency rooms. Since I know you wouldn’t do this, I just called the police and the DEA to investigate. They are coming over to speak with you, so don’t go anywhere.”
D. “You have received a lot of narcotics in the past several months. Let’s talk about this.”
4. An angry patient confronts you in the waiting room; screaming that he has been waiting for 3 hours. You:
A. Check his chart and yell back, “Liar! Your check-in time was only 94 minutes ago.”
B. Announce to the waiting room, “This fellow thinks he is more important than the rest of you. Who wants me to see him ahead of everyone else?”
C. Fall to your knees, pound of the floor, and shriek, “I can’t take this anymore damn it!”
D. Say, “You’re right; you have been waiting too long. I’m sorry. We’ve got a lot of critical patients but we’ll see you as soon as we can.”
5. Your administrator tells you that the patient satisfaction scores are down. You respond;
A. “I guess I should just give everyone Dilaudid; maybe then they’ll be happy.”
B. “Why should we care? They’re just a bunch of whiners who don’t pay their bills.”
C. “I’ve got to concentrate on the sickest patients, not pamper the “walk-ins” who have nothing wrong with them.”
D. “There was a great article on Patient Satisfaction on EM-blog. I’ll get my docs to read it.”
6. In the middle of the night you see an odiferous and unkempt street person who despite hours in the ED and a negative workup still looks quite ill. You,
A. discharge him anyway, since he has already survived this long.
B. tell the hospitalist, “this guy’s smelly, a real pain, and there probably is nothing wrong with him; but you still need to admit him anyway.”
C. order MRIs of various body cavities (with and without contrast) then turn him over to the next shift.
D. Ask the other ED physician on duty to see the patient and give you a second opinion.
7. Your resident is working up a 16 year-old teen with lower abdominal pain. He says he wasn’t going to order a pregnancy test because she says that she is not sexually active. You reply:
A. “You know what they call sexually inactive teenage girls? Mothers.”
B. “I’ve seen 100 cases of virgin birth; one more won’t surprise me”
C. “Listen puppy; maybe you should switch to family practice.”
D. “Don’t rely on a patient’s sexual history when it comes to pregnancy testing.”
8. A homeless alcoholic sobers up in your ED overnight. He says; “Doc, I haven’t eaten in two days. Can I have a sandwich?” You reply:
A. “If you didn’t spend all your money on booze you could buy your own sandwich.”
B. “Get a job.”
C. “If you feed the bears, they just keep coming back.”
D. “Turkey or ham?”
I admit these questions are pretty tough (I got all of them wrong, even with several tries).
Answers in next month’s column……
Reader Comments (2)
Great post, Steve. If only it didn't take a career to learn these lessons. Ron Hellstern
rhellstern@hospitalpractice.com
Great "questionnaire" ! Except I'd have to change the entry on question #4 from 3 hours to 16 hours for the question to be more realistic in my ED (Qc, Canada) - where we observe before we evaluate ;-(