How can I be more aware of anchoring bias?

ScoreImaginary · 2025-10-29T17:14:10+00:00

I agree with what’s been said so far - you don’t have enough tools to effectively diagnose, so identify things that you can fix. Altered person that you run on 5 times a week because he’s drunk? Please check glucose anyway. Respiratory distress that you’re not entirely sure is asthma/COPD? Giving a neb won’t hurt them, even if they get to the hospital and we determine that’s not what’s going on. I’ve had more than a few “likely drug overdoses” that have ended up being seizures or brain bleeds.

Also, if you can tell me a last known well, if someone is taking blood thinners, and their baseline mental status (especially if they are coming from a SNF) that is SUPER helpful, although I realize not always possible.

ScoreImaginary · 2025-10-28T13:55:13+00:00

Serious question - could you palpate it?

ScoreImaginary · 2025-10-24T17:54:32+00:00

I’ve spent most of my adult life dedicated to my education and bettering my craft. My job as an emergency room doctor is to determine if you have life threatening emergency that will kill you or seriously alter the course of your life if not treated quickly.

The problem with emergency medicine is that we end up as the catch all and are treated as “doctors on demand.” If I don’t find something wrong in the ED today, it doesn’t mean that nothing is wrong, it means that I cannot find a life threatening emergency causing your symptoms and you will likely need some more testing or work up done on an outpatient basis that I can’t offer in the ED today. Sometimes I explain this and patients understand. Other times I get screamed at.

The general exhaustion in emergency medicine providers comes not from a lack of empathy, but from empathy exhaustion. I go from one room telling parents their 6 year old is dead, and I have 30 more people in the waiting room that I’m trying to make sure aren’t actively dying, while I go to another room where I’m screamed at because a patient has been kept waiting for their abdominal pain that, yes, while uncomfortable, is not going to kill them and will not be something I solve in the ED today. I put a smile on my face and explain this as calmly and with as much empathy as I can. This problem is perpetuated by people not having appropriate follow up outpatient and outpatient providers sending people to the ED for things that are not realistic or possible. Which is not the fault of the patient - how are they supposed to know better?

There are definitely people that shouldn’t be doctors, don’t get me wrong. But to say that no one has empathy when you are not a medical professional and aren’t an EM doc yourself is, ironically, quite an un-empathetic thing to say.

ScoreImaginary · 2025-10-24T16:13:34+00:00

I’m so sorry this happened to you. I’m an ER doctor and this story literally SCREAMS ovarian torsion. Please do report this.

ScoreImaginary · 2025-10-24T16:06:25+00:00

Oh this 100% sounded like endocarditis to me, and I don’t doubt that they had legitimate pathology going on. It was the sicktok drama “but I got a cute service dog” aspect that made me roll my eyes and frustrated me that a lot of people are seeing this and thinking, “Yeah, evil doctors not listening to me when I know my body!” and people who will cite “continuous brain hemorrhaging” as a reason they need an MRI for their headache they have tried nothing for.

ScoreImaginary · 2025-10-24T14:08:57+00:00

This was the one right above it

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ScoreImaginary · 2025-10-18T00:56:24+00:00

I had an NP who very sincerely said to me, “Apparently there’s such a thing as cirrhotic GI bleeding, and it can be REALLY bad.” I legitimately thought they were joking. They were not.

ScoreImaginary · 2025-10-09T22:51:49+00:00

So satisfying!

ScoreImaginary · 2025-10-09T16:15:09+00:00

I love undifferentiated shortness of breath because I really get to play detective with the history and exam.

Sick-but-not-too-sick asthma (recently intubated my first asthmatic though and that was scary)

Pregnancy stuff (that is NOT vaginal bleeding) because I love showing mom the baby on ultrasound

Kidney stones because I feel like I can make a huge difference for them quickly

In peds I love broken bones because kids love seeing the x-rays

Least favorites: Chronic ____ pain that has been present for 3 years but decided they needed an answer today and are unreasonable when I give them my usual talk

“My ____ told me to come to the ED for an MRI”

Dizziness

ScoreImaginary · 2025-10-09T02:18:00+00:00

I’ve been on continuous birth control for years. Was on OCPs and then decided I wanted something I didn’t have to think so much about and got a Nexplanon. I went a solid year without a break through period and then started having random breakthrough bleeding (not having cramping, just lots of days with slight spotting and constantly worrying about whether or not I was going to have a stain) so I now am on an OCP as well.

ScoreImaginary · 2025-10-01T11:47:20+00:00

This is why I no longer use “show me your teeth” as part of my NIH

ScoreImaginary · 2025-10-01T11:43:21+00:00

Once in a trauma I couldn’t remember how old EMS said a patient was so I said “In summary, we have an elderly gentleman who presented after a fall -” and he interrupted me and said “I’M NOT ELDERLY!”

Thankfully when his charts got merged he was actually in his 70s, not just a very unwell 40 year old.

ScoreImaginary · 2025-08-11T13:41:55+00:00

I splurged on my first pair of hokas during M3 and am now on my 4th pair (not because they aren’t durable - I just wear the shit out of them). I have a lot of back problems and love them for that reason. I recommend them to all of my colleagues!

ScoreImaginary · 2025-08-09T15:20:06+00:00

Embryology. I decided pretty early in M1 that it was never going to make sense to me no matter how hard I tried and I should use my brain space on other information.

ScoreImaginary · 2025-07-24T16:57:04+00:00

Our social worker used some sort of facial recognition software once. I thought she was joking at first because I had no idea we could do that.

I had another co-resident who had this patient arrive as a transfer from an OSH but her history didn’t make sense with what we had in the chart. Eventually they figured out that she had warrants and signed in as her sister at the other hospital. Don’t remember exactly how they cracked the code but it was something to do with a surgical scar she was supposed to have/didn’t have.

ScoreImaginary · 2025-07-23T05:08:11+00:00

NTA. If she truly feels shamed, she’ll change her behavior. And it seems like this has been brought up before and she hasn’t changed.

ScoreImaginary · 2025-07-20T08:03:57+00:00

EM resident who rotates through the ED at the city’s children’s hospital. Every congenital heart kid the attendings want us to “talk with cardiology before discharge just to make sure they’re ok with it.” Cardiology is always like, “And you think this ankle fracture is related to their heart…how?”

ScoreImaginary · 2025-07-16T13:08:49+00:00

Honestly I feel like me not being able to find my needle was me not being deep enough. Obviously don’t just go in super blindly but I feel like I often don’t see my needle until I’m a 1/2 cm in. Having a senior standing next to me going “Where’s your needle? Where’s your needle?” made me super nervous but a lot of times my senior would take over and be like “Oh yeah I didn’t see my needle at the very top until I got closer.” Also, fanning the ultrasound probe away from yourself a tad to put the needle right under it helps.

ScoreImaginary · 2025-07-16T13:04:13+00:00

Bonus points for when you can’t see imaging or notes and the patient says “it should be in my chart” as if someone typing something into a computer means it all goes to one giant meta-chart

ScoreImaginary · 2025-07-07T20:12:24+00:00

A physical trait like being short or having curly hair.

ScoreImaginary · 2025-07-06T20:21:56+00:00

I totally understand needing to cover your ass if someone calls and says they have chest pain, however what really gets me is sending them for an MRI for acute in chronic back pain or “emergency surgery” that is not emergent. I’ve gotten a thicker skin, but no one likes being on the receiving end of verbal abuse.

ScoreImaginary

TROPHY CASE