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You're Right, I'm Wrong

Posted Jun 13 2010 5:11am
The second year, soon-to-be third year resident, said she was nervous about the fetal heart tracing. It just wasn't very reactive. She admitted there weren't any obviously ominous signs, but she just didn't like it. The patient was an expectant mother still three and a half weeks from who due date who just hadn't been feeling the baby move as much as usual.

As I talked to her on the phone and viewed the computerized strip from home on my laptop, I tried to reassure the resident I had seen far worse before. We both thought following up with an ultrasound test called a biophysical profile would be a good idea, but she wondered if we really had time for radiology to do their thing. As her attending I reassured her and made the call to send her for the additional test.

Upon return to the labor and delivery floor,the baby's heart beat was clearly worse. It was now obviously non-reactive and even somewhat gut wrenching to look at the monitor as each beat was plotted on the computerized grid. The decision was obvious at that point--call the obstetrician backing us up to do a C-section, and fast.

The operation went well and the baby looked surprisingly vigorous given its fetal heart tracing. The resident appropriately debriefed the case with the OB after the operation. The much more experienced obstetrician said retrospectively she probably would have done the C-section based on the initial tracing the resident was concerned about. She looked at the heart tracing of the same baby from a month prior and could tell that it just seemed like a different baby. She admitted though, hindsight is always 20-20.

I listened to the resident and reviewed the strips again. I could see their point, and while I'm not totally convinced I wouldn't make the same decisions again, they certainly gave me something to think about and improved my clinical skills.

As I got off the phone with the resident I told her, "Looks like this was an educational case for both of us tonight. You were right, you made a nice call."

The Country Doctor
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