"What we have here is a failure to communicate."

Over the past few months I have learned how imperative good communication is in medicine. I realize it's important in every area of life but we can't do our job successfully unless we are able to communicate well with our patients and with each other. Here is a prime example of a failure to communicate correctly between me, the PA I'm working with, the white board, the triage nurse, and the poor unsuspecting patient.

I randomly picked a chart up today out of the rack and it said "s/p colon resection c/o bloody muscousy discharge". On the board in the ER we have a floor plan of the entire ER and you write your patients name and chief complaint in the room that they are in. This guy's room was right next to another guy's room who was having rectal bleeding. I go into the gentleman's room and do an H&P as usual. Now somewhere between reading the chart, the board, and entering the patients room my mind decided that this patient was having rectal discharge. His entire H&P was based on the fact that I think he is bleeding from his butt. I must have asked the man 10 different questions regarding his bowel movements. We are talking extremely detailed questions like color, consistency, frequency, if he's been farting, etc. The guy just kept on answering them. He never once asked why I was asking him all of this stuff. I moved on to the physical exam. I pulled the blanket off of him and he had light reddish/pink wet stains on the front of his gown sort of over his crotch area. At this point I'm thinking 'Daaang this dude has blood coming the whole way up the front of him!' I lifted up his gown and he had a huge incision running from a few centimeters below his rib cage to just above his pubic bone. There is a serosanguinous discharge oozing very slowly from the bottom of the incision but nothing too crazy. My dense brain STILL didn't realize he was here for "incisional bloody muscousy discharge". I left the room and went and presented the case to the PA. She too was very confused by the case I presented. We both went back into the room and she started going over the same things I just did except after three questions she realized that he was here for his incision not his rectum!! As soon as we left the room I apologized and turned at least three different shades of red. Thankfully the PA I was working with is understanding of the fact that I am a stupid inexperienced student and just laughed at me.

I spent the rest of the day kicking myself and replaying that case over and over in my head trying to figure out how I could have gotten so far off base. I'm going to blame it on the fact that it was early this morning so I was not completely awake yet and the fact that it was busier in the ER than I'd ever seen it before. I'm just thankful we caught the error before I seriously violated him! Can you imagine the surprise on that man's face?! Needless to say I will be double checking everyone's chief complaints before walking through that exam room door.