Shotgunning

It's my third call and I'm anxious.  The first call was so horrible and the second was so much improved that I have no idea what to expect...but I do know that it's with anxiousness and trepidation that I accepted that little red pager this morning (the call pager).  I only have 3 patients so I am wide open for getting crushed by admissions...here we go.

So this little girl we have here presented to us with swelling of her legs below the hips and a rash that looks like it may have little tiny bleeds in it (petichiae - probably misspelled).  This kid was getting better and much improved from the history so I ran a few preliminary labs that would check generally for any worsening (blood count, inflamatory markers, and a couple common infectious diseases that present like this around here).  The next day I come in with a new attending who, without looking at this little girl, FREAKS OUT.  I'm inexperienced so maybe she had a right too and I just don't know any better.  Instead of conservatively ordering labs, she puts everything under the sun in her differential diagnosis (what could be causing this), even if it was VERY unlikely, she consults three different teams, and starts "shotgunning" labs. 

Shotgunning labs is where you get labs like you are shooting a shot gun at a diagnosis.  You don't try to narrow down or aim your labs...you just order thousands of dollars in time consuming mostly pointless labs and hope that you hit your target.

As expected it didn't work.  The reason we didn't get alot of labs is that the kid had recieved steroids and a host of different antibiotics before coming to us.  That's why we checked the "general" labs as well as a few likely culprits and decided to observe.  The reason for this is it's unlikely we will ever know what caused it.  The peripheral smear (where you actually look at all the cells in the blood) looked like a leukemoid reaction (where your WBC's can "over react" to a stressor/infection) and his white blood cell count and inflamatory markers kept getting better, so why torture this kid. 

I honestly don't know if I'm inexperienced and stupid for doing this or if my attending is the one who doesn't know what she is doing...my experience would be that it's me...but watching her order 10,000$+ in lab tests before even seeing the patient was sickening (not to say I would have been bothered had I considered it necessary). 

Anyways, she's getting better and better and will likely go home today...after we have done nothing at all...but cost tax payers alot of money. 

I don't want to totally come down on my attending.  There are different ways of doing medicine.  She is a liberal and I'm a conservative, in other circumstances her reaction would have been more acceptable...in this one I'm not sure it was the "most" acceptable, but all her labs she ordered were appropriate and would hold up in court should they ask her, "Why did you order this?"...it's a safer way to practice I guess, but I feel it's lacking in common sense. 

Newbie Doc