Me: “So, you were lightheaded and dizzy and then you worried that your blood pressure might be high so you took two extra doses of your blood pressure medication?”

Mr Hypoperfusion: “Yeah”

Me: “Let me guess. And then you passed out?”

Mr Hypoperfusion: “Yeah, I didn’t see that coming”

One thing I truly hate is when clinically something seems like a slam dunk but then some test proves you wrong. Many cases are debatable but some just read like Harrison’s – i.e. the patient’s clinical picture is right put of a text book. Still, sometimes for CYA reasons you have to do a test to completely rule it out (like because the pt had several risk factors) or because they demand it and you are just not up for an argument that day.
And then would you believe it, you’re wrong! The pt rules in! Perfect example, a woman with mild non-exertional chest pain, worse with rotation of the neck or when she presses on the area, and no SOB or other symptoms. Normal EKG. You do enzymes because she has a strong family history and is post menopausal and BAM! They’re positive. Very positive. Lucky for both of you but not lucky for clinical medicine.

I remember when I started my first job as an attending fresh out of residency. I actually did not have a lot of confidence but luckily went to a good training program with a lot of varied patient encounters and mostly good teachers.
Anyway, I guess it is a sort of rite of passage that new doctors go though – getting second guessed by the nurses, especially the old cranky “hens” as they are sometimes called. They would question many of my orders if it seemed the slightest bit odd. Now, of course new doctors make mistakes so I can understand it to a point and if it is done with some respect. This was not usually the case where I worked.
So, I had this guy come in with chest pain and obvious ST depression on his EKG. This old nurse immediately grabs the nitro and heparin. Well, I actually did something we are all technically supposed to do before with anitcoagulate. I did a stool guiac. Guess what, not only was it positive but it was grossly dark maroon!
Thus I ordered a unit of blood to be transfused stat. Well, this nurse just would not give it. Even after I explained what was going on. She still figured the guy needed to be anticoagulated because he was ischemic! The HgB came back 6.5 and she finally, begrudgingly started to get the unit of blood ready to be transfused. Just then, the cardiologist I paged came in and took one look at the situation and said, “Why the Hell is this guy not getting blood yet?! I just told him to ask the nurse since i had ordered the blood 30 minutes ago. She never gave me crap after that.