0:13
Hey Meg, how's it going?
>> You know, it's been a really busy week.
There's been so much flu.
>> Yeah, that's true.
Your a third year resident now right?
>> Yeah. I'm about to graduate.
>> Cool. All right.
Tell me about that patient.
>> So Betsy, she's a little two year old girl, brought in by her mom.
She's been seen three times in the last week.
Every time just said that she's dehydrated, sent her home.
You know, she hasn't been eating at all.
She's been sleeping a lot.
She's got cough, fever, runny nose.
When I went in to see her, she's really tachycardic.
She was just laying there.
I, if I really shake her she wakes a up a little bit, but
then just goes right back to sleep.
0:46
She's bounding pulses, and, and she, she really, she just.
But if you wake her up, she just cries, like screams.
0:54
But overall I really just think she's just a little dehydrated.
She probably has the flu that everybody else has.
So, I thought maybe I'd just try some Tylenol and
hopefully then she can just go home.
>> Okay.
Let's talk about the, this case.
I'd like to give you some feedback.
Is that okay?
>> Sure.
>> Great.
1:10
>> Boy, that was a tough one, that was a really sick kid that she was describing.
Lethargic bounding pulses, not aware and then she just thought it was the flu.
>> Right.
So this is the hallmark of interpreter in actually not doing a good job
being an interpreter.
So remember for
an interpreter, you want them to start using their clinical reasoning.
Start taking those pertinent parts of the history and then pertinent negative parts
of the history and forming a good differential diagnosis.
And that's really where she kind of fell off.
>> Hm-mm.
And so then when she tried to manage the patient, what happened?
>> Well, right, so she wasn't able to manage the patient alright because she
didn't have that first developmental step that comes before managing down pat yet.
>> Got it.
And so in fact she probably would have sent this septic kid home,
because she wasn't interpreting the data that she's got-
>> Right. >> correctly.
>> Right. >> Understand.
Now if that had been a student would it, would it be a manage level?
>> Right. So I think that's a great question,
that's where sometimes people have some difficulty when they're trying to
apply RIME.
Remember that RIME describes very specific behavioral actions that a learner takes.
And so it doesn't actually matter what level that they're at where it's a medical
student or a resident or an attending physician for that matter.
It's their behaviors.
So for this person, they were not able to give you interpreter function.
They were not able to prioritize, use clinical reasoning, so
that's an interpreter level.
2:28
>> And really a failure at the interpreter level.
>> Correct. >> It's recorded pretty clearly,
because I had a clear sense of what was going on with the patient, but
then couldn't make the interpretation that the patient was sick based on
that information.
>> Right.
>> Makes sense.
Good. Thank you.
Sally Santen, M.D., Ph.D.Associate Professor - Emergency Medicine
