The most common admission that we see on general medicine is chest pain, and at this point, I'm about 90% accurate on my calls. It's that 10% that presents so much trouble. And that's why I order enzymes even when I think I know. Because I'm just not sure.
It makes me think about those Pepcid Complete commercials where they show these 50-60 yr old folks with 'heartburn' and I'm thinking, "Umm... couldn't that be an MI?"
I'd like to think that I have that treasured 'clinical acumen' of an attending, where you can stare at a patient and walk away with some sort of quasi-impression of how sick someone really is.
The problem with this is that in order to develop this acumen, you've got to kill a lot of people. A lot. Because how do you know that someone's going to die if you don't kill a few people so you know what someone who's dying looks like? Seriously!
That's why residency is so nice sometimes. Every now and then when I kill a patient, it makes me think, and I try to put my finger on what I did wrong. Because I've done a lot of things wrong, and when I go home, at least I can tell myself that I'm working on developing my clinical acumen.