SCUT Monkey

Many books have been written on this topic and every medical provider has had to perform this role at some point in his or her career.  The role of the "Scut Monkey" is one that some do not desire for, to be honest, it can be an undesireable job.  But this work has to be done.  I have learned to fulfill this role mainly in the form of taking care of our "frequent fliers."  It has been challenging, but interesting, and up to this point I don't mind the job too much.

The situation is usually the same - the doctor (my preceptor) will say, "I think you should go see Mrs. Smith," usually with a sly glint in his eye.  The PA working in the department will say, "Ooooh, yeah!  Mrs. Smith will be a good patient for you to see," with a wicked grin.  Of course the PA really means, "This is going to be a challenging and potentially annoying case that will probably end with the patient making inane requests or having a laundry list of complaints a mile long that we have already worked up literally twenty times without any new results... so let's see if you can get all the right answers."  I try to dutifully march off to see the patient, but often I say to myself, "Not another one!"

It is here that I must take pause and mention something that my preceptor and the PAs in the department have already taught me - even frequent fliers get sick sometimes.  The same things that can afflict John Doe can effect Mrs. Smith, and it is in this type of patient that we will most likely miss a major medical problem, because we've heard it all before.  We have heard the complaints of abdominal pain, or back pain, or headaches a hundred times (sometimes literally) and there is never anything to point to an actual cause of the symptoms, so we think, "Why should this time be any different?"  Isn't the definition of insanity something along the lines of repeating the same exact activity a number of times and expecting a different result?  Admittedly, it takes a bit of a naive mind to subject oneself to the difficulties of getting an H&P on this type of patient, but that is exactly what I am - a naive mind.  I need to fill it with something, right?  Who better for a naive mind to see than someone who has a number of complaints without corresponding physical findings?  It is this patient who will challenge my diagnostic abilities the most - and one that I have the luxury of time to examine.  Will I be allowed to assess a patient in flash pulmonary edema?  Not likely - this patient's respiratory compromise warrants more urgency than a PA student in his second week of emergency medicine can provide, especially since this particular PA student has only seen one or two of these types of patients in his entire life.  But the frequent flier...  This is a patient that the doctor already knows and someone that will allow the PA student the time to perform a solid H&P and the appropriate tests in the hope that this naive mind might give them whatever it is that they seek.  And this is why it is a good experience for me to see our frequent fliers.

Interestingly, in one book on the topic of "Scut Monkeys" the charge was given to think of SCUT as an acronym for Some Clinically Useful Training.  My charge to those that come after me is to adopt a constructive view of scut work for we will all have to perform these tasks - but they are what you will make of them.