Thursday, March 8, 2012

Why I am I so grumpy?

Patient information and situations have been slightly altered for privacy reasons, but the essence of the stories is true.

A middle-aged woman was admitted to the medical service for symptoms of alcohol withdrawal. Her liver function tests were abnormal. Despite the fact that she had no abdominal pain, an ultrasound was ordered and showed a gallstone. The cognitive doctor called me and said he didn't think the gallstones were significant but would like me to see the patient and confirm his feeling. Asymptomatic gallstones do not require surgical intervention. Why can’t a cognitive doctor deal with this himself?

An emergency physician had a woman in the ED who had fallen down some steps and fractured her right humerus, clavicle and a rib. There was no history of loss of consciousness. Her total body CT scans were otherwise negative. He consulted me to "clear" her regarding possible other injuries before deciding on her disposition. Are ED MDs capable of assessing and "clearing" trauma patients or not?

A man was admitted to the medical service with gallstone pancreatitis. [Whether such patients should be admitted to medicine or surgery will be the subject of another discussion.] I was called for a consult at 2:00 a.m. Think about it. How likely was it that I was going to operate on this patient in the middle of the night? Hint: Not very.

The answering service of a surgeon I was covering for called me at 5:00 on a Sunday morning to tell me that a woman had called to say her husband, who had undergone surgery a few weeks before, was having pain. I called the number I was given, and the call went straight to voice mail. Through clenched teeth, I left a message stating I was returning her call and that if she wanted to talk to me she should leave her phone on and call the service back. When she called back a while later, I learned that the pain had been going on for more than 24 hours. Why couldn’t they have waited two more hours to call? And how about leaving the phone on to receive the call-back?

A patient of another surgeon I was covering for called me at 6:00 p.m. on a Friday to tell me he had just run out of pain medication. Wouldn’t it make more sense to call the doctor for a refill when one was down to say, two or three pills? By the way, this happens all too frequently. It always makes me suspicious that the patient is drug-seeking. They get just enough pills to last the weekend.

I was called to the ED to see a morbidly obese woman with an incarcerated ventral hernia. While taking a history, I learned that she had diabetes, hypertension, asthma, sleep apnea, hypercholesterolemia, arthritis, atrial fibrillation and was taking prednisone and Coumadin, as well as 15 other medications. Her primary care physician, all of her specialists and the surgeon who had performed all of her previous operations practiced at another hospital. Why did she come to my hospital? She said she knew she wouldn’t be kept waiting as long in our ED.

Horace Greeley: “Common sense is uncommon.”
Skeptical Scalpel: “Common sense cannot be taught.”


Dr Nikola said...

ROTFL. Of course you know you sound very grumpy and unsympathetic for all patients that happen to read your blog. But you sound perfectly normal to me. It reminds me of a lady who came to my ED 3 am with a huge growth on her shoulder - I would say it could have been about 3 or 4 pounds - asymptomatic except the visible lump. The only thing I could utter was: 'But you are not going to tell me that this thing appeared an hour ago?'.

Skeptical Scalpel said...

Great story. It's happened to me many times.

Anonymous said...

I understand the issue very well. Long ago, before retirement, when the world was young, I was a busy Ob/Gyn in Western New York. One Saturday at about 1:30 am I took a call from a patient who wanted to know where she could get an emergency IUD because she was at a party and might need it. The party was in Detroit. It was the only time in 40 years I actually hung up on a patient.

Skeptical Scalpel said...

Wow! Great story. You topped me. I wonder if anyone can beat that?

Anonymous said...

Well, probably not going to beat that, but similar to your stories:

Many years ago, when I was a cardiology fellow in NYC, we provided coverage for the private practice cardiologists at our hospital on weekends. Some of the cardiologists did some general internal medicine as well.

One Sunday morning at 5AM I received a call from a patient who told me he was calling because he was aware that after a tick bite, antibiotic prophylaxis for Lyme Disease needed to be started within 24 hours to be effective. I asked him when he had gotten bitten, and he said "last weekend."

So of course I asked him why, if he already knew it was way too late to start antibiotics, he was calling, and why he was calling at 5AM.

His response: "My wife and I couldn't sleep and we were arguing about it, and so I just wanted to prove to her that I was right."

Of course, I thanked him for the call and told him to feel free to call back anytime if he and his wife had any other questions.

Skeptical Scalpel said...

Not quite as good as the IUD story, but close.

Libby said...

I'll have to give my mom credit for instilling common sense into Friday night at 9pm she picked me up at the local hospital where I had just finished a shift as a Candystriper and she commented on the "9pm Mothers who wait until 9pm to seek a doctor about their baby's fever/illness that had been going on all day" She thought they should wait until morning or have called the doctor during office hours.

To quote my high school drama teacher "some people's kids" and shake his head.

Skeptical Scalpel said...

I agree. What's worse is that "some people's kids" grow up to be adults.

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