Burn-out is a phenomenon consisting of emotional exhaustion, feelings of cynicism/detachment, and a sense of being ineffective at one’s work, that threatens the well-being and safety of both physicians and the patients they treat. It is known to be a harbinger of work/home conflicts, health problems, and suicide among physicians.
The Mystery Case series was initiated by the Neurology® Resident & Fellow Section (RFS) with the aim of honing the clinical reasoning skills of trainees. The idea was simple – take a nice teaching case submitted to RFS, and recast it as a brief vignette, typically presented with a set of relevant clinical- or neuro-images from the original case, and then generate a set of relevant questions that would serve to highlight the key teaching points of the case. The questions would generally move from general (key findings, differential) to specific (most likely diagnosis, best diagnostic test), mimicking the real-life diagnostic process.
“What do you mean, you can’t get a head CT tonight? This man is having a stroke!”
My frustration must have seemed utterly naïve to the rural emergency physician on the other end of the line. It was 0100 on a Saturday, and I was taking a telephone consultation at a hospital in northern England, about a patient who appeared to have developed classic symptoms of a lateral medullary stroke. In the heat of the moment, I had forgotten that I was no longer in my familiar comfort zones of the John Radcliffe Hospital (Oxford) or the Foothills Medical Centre (Calgary, Canada), where I could always count on an emergent CT scan for an acute stroke. Fortunately for the patient in question, we could quickly arrange for the patient to be transferred to my centre for urgent neuroimaging and stroke-unit admission.