Dramatic presentation

There is a lot of acting involved in medicine. I saw for the first time, in outpatients, a girl with precocious puberty. It's something I'd read about in books, but had never before encountered in real life. But I had to pretend I knew all about it (well, I did afterall know all about the theoretical aspects) and not let on that this was the first case I'd ever seen. The "it might be a brain tumour or it might be nothing" bit (obviously said in other words!) was particularly tricky to convey.

Last night was a particularly horrendous shift, not because of any of the patients, but because I developed a terrible headache on the way to work - it's a truly bizarre experience feeling car sick from your own driving. But there I was at work, and the day shift person was waiting to go, so I took a couple of ibuprofen and got on with it. They didn't do much for the pain, and did even less for the nausea. And then a teenager staggered in with diabetic ketoacidosis (DKA). He was pale, drawn and sunken-eyed, and retched continually as I spoke to him. When I leaned over to examine his abdomen (taking care to give the right iliac fossa a good prod), I felt like I might be sick myself. Luckily my brain clicked into DKA autopilot, and (with help from my SHO) we did the required blood tests, got lines in, and I even managed all the fluid calculations in between seeing a sick toddler who had arrrived at the same time. The hard part was again the acting - I imagine a doctor who looks like they've done it before (true, in this case) inspires confidence, but the danger lies in the temptation to "process" the patient by algorithm, thus failing to convey the seriousness of the situation.