I Am the Smartest Man Alive

As third year medical students on an inpatient rotation, it's expected that we go home and study our patients' conditions every night.  Typically, we present what we learned from our review of the literature during rounds the next day, especially with regards to how our therapies should be adjusted based on the latest treatment algorithm or clinical trial data.  Unfortunately, the responses I get from my attendings and upper-level residents usually go something like this:

"Yes, I'm aware of that study, but this particular patient doesn't fall into those guidelines because..."

or

"That's not a very strong paper, and from my own clinical experience, I've found it better to..."

or

"I completely agree with you, and that's why we started the patient on that regimen last night after you left."

Well, ridicule me no more, because today, I made what may have been my first productive contribution to medicine... ever.  My team is currently taking care of a patient with toxic shock syndrome who has been on IV vancomycin and ceftriaxone.  This morning I mentioned that in my readings, I had come across a paper that recommended the use of IV clindamycin, which inhibits ribosomal translocation and thereby decreases the production of TSST-1, the toxin that gives rise to all of the symptoms associated with the disease.  I also brought up the idea of discontinuing the ceftriaxone, since we were no longer worried about gram-negative coverage.  And Dr. Jaworski said, "That's a great idea; let's stop the ceftriaxone and start clindamycin."

BOOM!  Hand over that medical degree.