Tuesday, June 25, 2013

Little black book

Early on in my career, while I was but a neophyte PA student in a pressed white coat, eyes as big as saucers and hands that shook while doing procedures (probably a voice that shook, too), someone gave me a great piece of advise.  That was that I needed a little black book.  Not one for phone numbers...  No, no - I am many years beyond that stage (and a wink goes out to my beautiful wife).  Rather, our little black books should contain the tidbits of information that will need to be remembered precisely but that will flee our minds over time. 

What is the differential diagnosis for a reactive thrombocytosis (white blood cells are elevated in the absence of an infection)?  I can't remember these off the top of my head, but I have the 18 most common causes listed in my little black book.  If a person's hemoglobin A1C is 8.5, what has their average blood sugar been over the preceeding 3 months (yes, Dr. Evans, I know that the average life span of a red blood cell is 120 days and thus the A1C can actually extrapolate back 4 months in time...  I have not forgotten).  That, too, is written in my little black book.  What Arlet & Ficat stage is a femoral head that shows subchondral collapse and flattening of the femoral head?  Well, stage III of course - thanks to my little black book. 

On and on it goes.   I have written down common antibiotics to be used for obscure conditions.  I have written down how to firmly diagnose someone with having Fibromyalgia (you have to identify 11 positive areas of point tenderness that have pre-defined locations).  I can calculate corrected serum calcium levels for a low albumin.  I know the mangement goals for a woman who has gestational diabetes mellitus.  All because I wrote them down in my little black book. 

Because I am still a neophyte, my eyes will still occasionally grow to the size of saucers (though much less commonly now), and because I forget things.  I can't keep it all straight.  And thus the little black book is invaluable.  Truth be told, it was something I should have started while in PA school so that I could remember that the 3 most common causes of otitis media are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarhalis.  Oh...  I guess I did remember something from school. 

My advise to all those in practice and learning to practice: get a little black book.  The earlier, the better. 

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