Wednesday, March 23, 2005

The Attending Sign

As both a former medical student and a current clinical preceptor, I have experienced the Attending Sign from both sides. All medical students, and hopefully all attending physicians, have experienced it, too. I never knew it by that name, but I've observed it even by myself. That is, I'll ask a patient a question and get an answer. Then I'll ask the same question later in the same interview and get a different answer. Why? I think it's mostly because patients forget details and events, and remember them better after someone jogs their memories. Sometimes it's because they didn't quite trust you enough the first time you asked it. And rarely it's an intentional attempt to deceive.

This article discusses the Attending Sign (AKA Why do patients need to be asked things five times?)
"The patient is having an adverse drug reaction," I announced as I walked out of Mrs. J's E.R. room holding a bottle of antibiotics that had recently been prescribed to her. The medical student assigned to the patient looked sheepish and the senior resident looked surprised. Along with the emergency-department registration staff, the triage nurse, and the nursing student, they had already asked Mrs. J. if she was taking any new medications. Yet the patient waited to tell me--the attending E.R. doc and the final and most senior questioner--about her new antibiotics.