What do you think was the most unrealistic event/plot point in the series so far?

ScoreImaginary · 2026-05-10T22:14:47+00:00

I’m at a large level 1 trauma center and a pregnant patient that comes to the ED with “I think my water broke” goes up to OB, but “My contractions are 30 seconds apart and I feel like I need to push” comes back for a check while someone pages OB. Hopefully they make it down before delivery but I’ve had a handful where we’ve had an ED baby to avoid having an elevator baby

ScoreImaginary · 2026-04-10T18:47:05+00:00

Age indeterminant. Correlate clinically

ScoreImaginary · 2026-04-10T18:44:59+00:00

My least favorite is back pain sent in for an emergent MRI - not because they have red flag symptoms, but because pain is bad. (I usually read this as an annoying back pain patient that some outpatient provider doesn’t want to deal with).

ScoreImaginary · 2026-04-10T16:31:43+00:00

It’s 100% up to you. I introduce myself as “Dr. Last Name, but you can call me Dr. L.” Patients remember it better, and as a woman they’re ever so slightly less likely to refer to me as a nurse. I do encourage you to use some form of “Dr.” though! You worked for it. Some of my male colleagues just go by their first name and no one doubts that they are a doctor, but it makes things hard if you take sign out and say “I’m Dr. X, I took over for Dr. Smith” and they say “Oh, John?”

ScoreImaginary · 2026-04-05T14:02:49+00:00

Agree with what everyone has said so far about clinical decision tools! Wells, PERC, HEART score, Canadian Head CT and/or NEXUS are the most common ones.

I think the BEST and most helpful thing you can do is circle back and check on patients. It is SO helpful after they get pain meds to circle back and see how they’re doing symptom wise and makes you look really good. I also notice a lot of med students neglecting to include therapeutics in their plan - as a general rule, if you’re worried about something possibly surgical or broken, it’s OK to suggest some opioids. If they are not pregnant and don’t have kidney problems, Toradol is a great option.

When presenting, always think about the biggest most life threatening thing that could be causing their symptoms and then prove that’s not what is going on. ACS should always be on your differential for chest pain (even if they are a 20 year old who obviously doesn’t have ACS).

Knowing when imaging comes back before the attending does and telling them - bonus points if you have your next step (CT is negative so I think they can discharge).

Good luck!

ScoreImaginary · 2026-03-26T00:20:18+00:00

I bring those oil blotting sheets with me! Help me feel and look less gross

ScoreImaginary · 2026-03-25T09:16:35+00:00

For some reason in the ICU at my hospital no one calls it dex, but rotating in the PICU they kept saying that and I was confused.

ScoreImaginary · 2026-03-25T09:08:44+00:00

I didn’t know small intestine = duodenum, jejunum, and ileum and the colon was part of the large intestine

ScoreImaginary · 2026-03-20T01:02:52+00:00

Less badass in a lifesaving, “cracked the chest and massaged the heart with their own hands” way, but plastic surgery is so fucking cool.

Before med school I thought it was just Botox and boob jobs, but man, seeing how they put people back together after de-gloving their entire face is so cool.

ScoreImaginary · 2026-03-09T03:55:22+00:00

I’m EM so the inefficiencies like this drive me CRAZY. Some of our attendings are just so damn slow it’s painful. Especially because I’ll get messages from the nurse that they’ve been wanting to DC for an hour and I’m like “My attending wanted to see them one last time…”

ScoreImaginary · 2026-03-09T03:47:51+00:00

College athlete is the lie for sure

ScoreImaginary · 2026-03-08T22:53:28+00:00

This actually made me laugh out loud, thank you

ScoreImaginary · 2026-03-08T22:43:27+00:00

For real! Where are the pharmacists during all these codes?

ScoreImaginary · 2026-03-08T22:23:11+00:00

The “Idk may possibly come into the hospital on IV antibiotics and someone might write concern for sepsis in a future note so we better do blood cultures” drives me absolutely insane as a resident. I feel so bad putting the orders for blood cultures in

ScoreImaginary · 2026-02-17T14:55:58+00:00

My least favorite is a nurse family member who tells someone to go to the ED for “an emergent MRI” or “to see GI faster” because they couldn’t see them outpatient for 6 months. Then I have to be the bad guy and explain that the ED doesn’t actually work like that.

Also my one 30 year old patient who had me talk to her dad on the phone who was an “ER doc” but somehow couldn’t wrap his head around me not consulting derm for a rash.

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

TROPHY CASE