The non-event worth a thousand successful procedures

The junior doctor's dilemma—how “happy” must you be with your diagnosis and treatment plan before you proceed without seeking a senior doctor's advice? I decided I needed to be happier, which proved to be the correct course of action.

The patient in question presented with shortness of breath, nothing new in a patient with known chronic obstructive pulmonary disease. The radiographer arrived, and the resultant chest x ray looked like a large pneumothorax. I quickly checked on the patient (stable) and his trachea (central) to ensure that I had not just requested the “film that should never have been taken” before skipping off to show the senior house officer. I had thoughts of chest drains running through my mind, and so was heartened by the senior house officer agreeing with my diagnosis and management. Sadly, she could not supervise me, so I should contact the registrar. The registrar would meet me on the ward shortly—fantastic, still on target for my first drain.

On returning to the ward, I found that the patient's old notes had turned up. I sat down to have a read and wait for the registrar. My eyes fell upon a sketch of a chest x ray remarkably similar to the film on the light box. The patient did not have a pneumothorax but did have bullae emphysema. With this discovery, all procedural opportunities evaporated.

I now sketch chest x rays in patients' notes, a practice I find remarkably useful, and try to play devil's advocate to any invasive procedures no matter how keen I or others are to perform them. I had to wait for another opportunity for my first chest drain, but this was preferable to my first being inappropriate.