The stories on mitral stenosis get more and more interesting. The Resident Doctors have their own assessment of their seniors. They believe that they can categorize their seniors into different types, and that they are predictable. They think the seniors have their own (irrational?) whims and fancies. They tell each other and their juniors what their bosses like and dislike, and what they will say and do in different situations. It is something like the students tell the future batches what jokes certain teachers will tell in lectures on certain topics. It is no wonder that they categorized me too. I don't blame them. How would they know I was different? In fact, they probably believed nobody was different.
This story took place about a year after the last one. That day I saw a pregnant woman with a left parasternal pansystolic murmur in her heart. It was due to a congenital hole in the septum between her cardiac ventricles, what is known as ventricular septal defect. I wanted my resident doctors to learn and also wanted to see which of them were good. So I took the woman's permission, called them one by one and asked them to auscultate her heart. Their answers were as follows.
Out of nine resident doctors, six diagnosed it as mitral stenosis. The only reason for them to mistake a loud, clear murmur that lasted throughout the systole for a milder, rough murmur that lasted mainly in the middle part of the diastole, could be that they had been primed by their seniors. They had been told that some time I would call them for auscultating a woman's heart, and that it would be mitral stenosis.
It was a double whammy for me. The first one was that they were not good with the murmur business. The second was that they believed they could successfully predict what I would do, implying I was one with stereotype thinking, and they were infinitely more smart than I.
This story took place about a year after the last one. That day I saw a pregnant woman with a left parasternal pansystolic murmur in her heart. It was due to a congenital hole in the septum between her cardiac ventricles, what is known as ventricular septal defect. I wanted my resident doctors to learn and also wanted to see which of them were good. So I took the woman's permission, called them one by one and asked them to auscultate her heart. Their answers were as follows.
Doctor
|
Diagnosis
|
First year resident doctor 1
|
Normal heart sounds
|
First year resident doctor 2
|
Mitral stenosis
|
First year resident doctor 3
|
Some murmur
|
Second year resident doctor 1
|
Mitral stenosis
|
Second year resident doctor 2
|
Mitral stenosis
|
Second year resident doctor 3
|
Ejection systolic murmur
|
Third year resident doctor 1
|
Mitral stenosis
|
Third year resident doctor 2
|
Mitral stenosis
|
Third year resident doctor 3
|
Mitral stenosis
|
Out of nine resident doctors, six diagnosed it as mitral stenosis. The only reason for them to mistake a loud, clear murmur that lasted throughout the systole for a milder, rough murmur that lasted mainly in the middle part of the diastole, could be that they had been primed by their seniors. They had been told that some time I would call them for auscultating a woman's heart, and that it would be mitral stenosis.
It was a double whammy for me. The first one was that they were not good with the murmur business. The second was that they believed they could successfully predict what I would do, implying I was one with stereotype thinking, and they were infinitely more smart than I.
