One Dozen Things
U.S. Graduate Medical Education
Scenario Script
A patient, wearing a gown, sits on an examination table. Three residents and an attending stand around the patient.
Attending: Alright Mr. Lopez, we appreciate you allowing all these young doctors to talk with you and hopefully getting all the information we need to come up with the best course of treatment for you. We are gonna step out into the hall right now to discuss your case and your resident, Dr. Klein [motions to Resident 1], will be back in to bring you up to date. Do you have any questions?
Patient: No, I don’t think so. I hope you can help me…
Attending: We’re gonna do the very best we can. Okay, bye for now. Thanks.
[All doctors say goodbye and thank the patient as they leave the room. Cut to the hallway where the doctors stand in a group.]
Attending: Ok, folks. Jackie, he’s your patient. What’s your working differential? Why don’t you start with the anemia, since that’s clearly one of his problems.
Resident 1: Well, he’s definitely anemic so we’re thinking… I always want to think first of occult blood loss… then some kind of malabsorption syndrome… anemia from chronic disease… I don’t think there’s anything in his labs or his story to suggest any red cell production disorder… hemolysis.
Attending: Very good. So John, how are you going to differentiate between the anemias?
Resident 2: Uh… I’m not sure…
Attending: Sam, help him out.
Resident 3: You mean like red cell indices?
Attending: Exactly! So, John, redeem yourself…what are those indices gonna tell you?
Resident 2: Well, a low MCV goes along with iron deficiency, and a high MCV, like 120, is B12…
Resident 3: … and I think a low MCV can also be sickling or something like Thallasemia…
Attending: Well, that would make things more interesting! Although I’m not sure about sickling, [to Resident 3] why don’t you look that up.
Resident 3: OK.
Attending: So, Jackie, what does the MCV tell us? Does it fall in the middle?
Resident 1: Pretty much normal… I guess it doesn’t help much.
Attending: Okay, so what other indices do we need to consider then?
Resident 3: Well, it’s always possible that his anemia could be caused by… [scene fades out as discussion continues].
