Things I Learn From My Patients

[leviathan]

Nitroglycerine is for chest pain only. Don't take it as a gereral tonic for whatever ails you. Especially don't take it for lightheadedness.

I had an 80 yo F who had a UTI and dehydration, borderline septic. CC was weak and dizzy whenever she stands up. She started taking her sublingual nitros 2 at a time "because I thought it was my heart and it wasn't getting any better." BIBA with a BP of 65/35. Fortunately she responded to IVF.

I can't say this is that out of line. I suppose this is either due to a deficiency in her medical treatment, ie., her doc didn't educate her enough about what are signs of angina pectoris/MIs and when to take her nitro, or she just simply forgot.

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[Paws]

Have you considered marketing an at-home menstruation test? My partner and I toyed with this a while back and had cool, catchy names like "My Time?", or "MMM" (monthly menses monitor).

For an extra fee you could include a nifty questionaire and call it the "My Time PLUS". The card would be laminated and come with a grease pencil so you could check yes or no multiple times. Questions would include:


Does fatty Mexican food and a pair of sweats sound like a good idea right now?

Dude! I laughed right OUT LOUD on this one !!!

 

[docB]

I can't say this is that out of line. I suppose this is either due to a deficiency in her medical treatment, ie., her doc didn't educate her enough about what are signs of angina pectoris/MIs and when to take her nitro, or she just simply forgot.

It's a running theme. I just had another near-syncope-so-I-took-my-husband's-nitro-and-turned-it-into-a-full-blown-hypotensive-episode-with-runs-of-sustained-V-tach pt yesterday. Too many people have a really poor understanding of their meds and I don't know that it's their PMD's fault. They have no interest in knowing about their meds. How many time have you asked someone what their meds are and been told "my wife knows that" or "I don't know. It's in my records." Lots of people just view nitro as "heart pills" and take them whenever they feel sick because it might be their heart. I've seen pts that do that with dig, coumadin, diltiazem and crack. You just can't win.

 

[Sessamoid]

It's a running theme. I just had another near-syncope-so-I-took-my-husband's-nitro-and-turned-it-into-a-full-blown-hypotensive-episode-with-runs-of-sustained-V-tach pt yesterday. Too many people have a really poor understanding of their meds and I don't know that it's their PMD's fault. The have no interest in knowing about their meds. How many time have you asked someone what their meds are and been told "my wife knows that" or "I don't know. It's in my records." Lots pf people just view nitro as "heart pills" and take them whenever they feel sick because it might be their heart. I've seen pts that do that with dig, coumadin, diltiazem and crack. You just can't win.

I get the feeling that leviathan sees a very different patient population than we do, docB.

 

[Annette]

If you have to smell your underwear before you put it on, it is time to change it.

 

[stoic]

If you have to smell your underwear before you put it on, it is time to change it.

ummm only if they smell bad. i'll admit to using this trick to postpone doing laundry a few times.

 

[v-tach]

It's a running theme. I just had another near-syncope-so-I-took-my-husband's-nitro-and-turned-it-into-a-full-blown-hypotensive-episode-with-runs-of-sustained-V-tach pt yesterday. Too many people have a really poor understanding of their meds and I don't know that it's their PMD's fault. They have no interest in knowing about their meds. How many time have you asked someone what their meds are and been told "my wife knows that" or "I don't know. It's in my records." Lots of people just view nitro as "heart pills" and take them whenever they feel sick because it might be their heart. I've seen pts that do that with dig, coumadin, diltiazem and crack. You just can't win.

I know what you mean with that. It drives me crazy when I am on a squad call and ask a pt what medications they take and they respond with "some heart pills" or "blood pressure medication" or some completely non-helpful answer like that.

 

[Sessamoid]

I know what you mean with that. It drives me crazy when I am on a squad call and ask a pt what medications they take and they respond with "some heart pills" or "blood pressure medication" or some completely non-helpful answer like that.

My favorite is when I ask them which blood pressure medication they're taking, they answer with "the little white one." Then they look at me like I'm supposed to know which one they mean!

 

[bemused]

Oh, come on, y'all! Didn't you know that it's all in the patient's record at the hospital? All their meds, PMH, PSH... all of it! Just ask my patients, they'll tell you so!

And you should always call an ambulance when you take an AB for pain and you don't get better. They made the pain of the (earache, pee ache, insert your favorite here...) go away, but when your wrist hurts and the penicillin pill doesn't make it better, there must be something REALLY wrong with you!

 

[v-tach]

My favorite is when I ask them which blood pressure medication they're taking, they answer with "the little white one." Then they look at me like I'm supposed to know which one they mean!

UGH. That's even worse than them replying "I don't know"!

 

[supercut]

My favorite is when I ask them which blood pressure medication they're taking, they answer with "the little white one." Then they look at me like I'm supposed to know which one they mean!

I used to try to explain (briefly) that such a description is of no help, becuase I have no idea what any of the pills look like. I stopped trying when I was always rewarded with a totally stunned facial expression and the word "REALLY???"

 

[docB]

I used to try to explain (briefly) that such a description is of no help, becuase I have no idea what any of the pills look like. I stopped trying when I was always rewarded with a totally stunned facial expression and the word "REALLY???"

A few times I've taken them one of the dictionary sized pill ID books and said "Let me know when you find it." It's fun to do and a lesson the pt will remember but it usually take too much time.

 

[Febrifuge]

Evil!

...in a good way. I like it.

 

[Siggy]

Well, I?m only a pre-med volunteer at this point, but I've got a couple:

1. If you have a history of dislocation your shoulder, by all means, jump off of your roof onto one of those Velcro wall things. Your RN will label you TSTL (too stupid to live).

2. Its time to lay off the Xanax when the volunteer that is there for 1 4-hours shift a week recognizes you.

 

[Apollyon]

If you are going to be cool and use Google! to translate your discharge instructions into Spanish, try to pre-read what you've done, so that, when the name "Victor" is translated as "el vencedor", you don't have to feign ignorance when the patient and family ask who "the winner" is, and why the DC instructions are now incomprehensible.

 

[docB]

2. Its time to lay off the Xanax when the volunteer that is there for 1 4-hours shift a week recognizes you.

If you are going to be cool and use Google! to translate your discharge instructions into Spanish, try to pre-read what you've done, so that, when the name "Victor" is translated as "el vencedor", you don't have to feign ignorance when the patient and family ask who "the winner" is, and why the DC instructions are now incomprehensible.

LOL Totally Hilarious! I showed this to one of my partners who speaks fluent Spanish and he almost wet himself. He is faxing it to one of his friends (named Victor).

 

[leviathan]

It's a running theme. I just had another near-syncope-so-I-took-my-husband's-nitro-and-turned-it-into-a-full-blown-hypotensive-episode-with-runs-of-sustained-V-tach pt yesterday. Too many people have a really poor understanding of their meds and I don't know that it's their PMD's fault. They have no interest in knowing about their meds. How many time have you asked someone what their meds are and been told "my wife knows that" or "I don't know. It's in my records." Lots of people just view nitro as "heart pills" and take them whenever they feel sick because it might be their heart. I've seen pts that do that with dig, coumadin, diltiazem and crack. You just can't win.

Definitely, if they are ignorant of the medications they are taking and implications for taking them because they simply don't care, then yes, I would be quite annoyed too.

 

[leviathan]

I know what you mean with that. It drives me crazy when I am on a squad call and ask a pt what medications they take and they respond with "some heart pills" or "blood pressure medication" or some completely non-helpful answer like that.

I actually had the same problem last week...Pt. with partial amputation of left ring finger comes to me, and while taking history, when I ask if he is on any meds, he answers, "Oh yeah, a whole crapload of 'em!"

"Can you elaborate?"
"Yeah, blood pressure lowering drugs, cholesterol lowering drugs, and all these other heart pills."
"It would be helpful if I knew which drugs they were, what dose and frequency you take of each, and whether or not you have taken them today."
"How the hell am I supposed to know that..."

And the conversation basically went to that tune, absolutely nowhere.

 

[leviathan]

I actually had the same problem last week...Pt. with partial amputation of left ring finger comes to me, and while taking history, when I ask if he is on any meds, he answers, "Oh yeah, a whole crapload of 'em!"

"Can you elaborate?"
"Yeah, blood pressure lowering drugs, cholesterol lowering drugs, and all these other heart pills."
"It would be helpful if I knew which drugs they were, what dose and frequency you take of each, and whether or not you have taken them today."
"How the hell am I supposed to know that..."

And the conversation basically went to that tune, absolutely nowhere.

Speaking of which:

If you're an electrician who decides he is going to be extremely rude to an emergency crew for requesting a hookup to power their ambulance at a park event, it would be wise not to slip and catch your ring on a nail that severes half of your finger....you might be a little embarassed coming back for help.

 

[Apollyon]

I have a mission this weekend - to find out who is paying for the advertising on Univision and Spanish International between 2am and 4am, saying "Ahora - HORITA! Es el tiempo por una cita en la sala de emergencia!" (For those who don't know - "Now - RIGHT NOW! It's time for a visit to the ER!")

And, if I find out that these ads have been paid for by those two dudes, who SHOULD be minding their own business, sitting on their porch, reading the Bible, with Grandma - well, I'll be angry!

 

[FoughtFyr]

I have a mission this weekend - to find out who is paying for the advertising on Univision and Spanish International between 2am and 4am, saying "Ahora - HORITA! Es el tiempo por una cita en la sala de emergencia!" (For those who don't know - "Now - RIGHT NOW! It's time for a visit to the ER!")

Wait three weeks. When the message changes to "Now - RIGHT NOW! It's time to sue!", you will know who sponsored the message. Just call the flashing number on the screen.

- H

 

[Apollyon]

It's a weird feeling - the duality of the laughter and the guilt from the 7 y/o with encopresis that is now absolutely INSANELY screaming about the soap suds enema (which the nurse says, rightly, "there's NOTHING 'touchy-feely' about it, no matter how warm the water"). Then there's the walk by the room, with the vaguely absolutely rank smell of foul flatus hanging in the air...but, then, the magic words in the chart - "large hard stool". Victory!

 

[IdiotBoxen]

Lemme get this straight. You've had a breast lump for 19 years and you get the compulsion to come into the ER at 3am. WHY!?! WHY?!?

This week has been especially bad because it's when year 12 school leavers finish their exams. And they've got time on their hands. At least the ones coming to see me seem to be serious about birth control. It's the ones I see in 3 months that are the problem.

When a patient insists that her oral contraceptive is a CIA mind control drug and that she's the reincarnation of Joan of Arc... don't ring me. RING PSYCH!!

Delivered a baby girl this morning... and I gotta say, this is the most strikingly beautiful baby i've ever seen. I hope I never lose the feeling I get when I deliver a child...

 

[docB]

If you come to the ER with the already jackasstic complaint of "I cough when I smoke dope" you should expect that my advice will include and admonition to stop smoking dope. If you reply that you're not going to stop you can expect a script for an inhaler and a referral to the local drug abuse treatment center. If you then get mad and yell at me because "I didn't do anything for you" I will, in a very calm and meticulous manner, beat you until you soil yourself. I'd call that standard of care.

 

[jashanley]

If you are going to swallow razor blades...thanks for being nice enough to tell us that it was 2 and you did it for drugs. A number and a motive make my job easier.

Please come to the ED at 4am for a check up because the police told you to..........then tell me you ran away from home for a week, had sex with a 19 yo guy when you are 16 and make me spend an hour speaking to the police and performing a rape kit. Then let me find out you did this a week ago and already had a kit performed from the same guy. That is what I want to do for the last hour and a half of my painful night shift. Thanks. My faith in parenting restored.

 

[margaritaboy]

If you come to the ER with the already jackasstic complaint of "I cough when I smoke dope" you should expect that my advice will include and admonition to stop smoking dope. If you reply that you're not going to stop you can expect a script for an inhaler and a referral to the local drug abuse treatment center. If you then get mad and yell at me because "I didn't do anything for you" I will, in a very calm and meticulous manner, beat you until you soil yourself. I'd call that standard of care.

I swear you actually working in our ED. There must be a pipeline from Reno to Phoenix where these patients are siphoned on a seasonal basis.

 

[stoic]

this one takes some sort of cake guys. i don't know what i learned from her, other than some people are just unbelievablely stupid.

44 y/o frequent flier. previously diagnosised CAD... BUT has refused to get cathed (i don't know why they didn't do it at the same time as the angiogram either). lives on a diet of fast food and cigarettes and comes to the ED several times a month complaining of severe chest pain. obviously this isn't someone you can just let walk out the door, seeing as how she could have an AMI at any time. she's openly non-compliant with her meds (she can't afford them... wouldn't want to take away from her big mac's and cigarettes), and says if you try to admit her she'll sign out AMA (she's done so many times before... as soon as she gets moved onto the floor she bolts). however, she demands that you treat her chest pain. 20mg's of MS (that's right, 20... it takes a lot when you weight 350lbs) she's getting "some" relief but still having chest pain. the best we've ever been able to do is get the pharmacy to fill some of her meds for free and have her sign out ama from the ED. I haven't seen heard anything about her in awhile and honestly i don't know if that's because she got tired of us being rude to her or if she finally died.

this patient =

 

[joaquin13]

I was working a medical student rotation at an extremely busy county hospital. Halfway into my shift, this patient, a 50ish African-American male, who was admitted, for one of many things, severe CHF, uncontrolled DM, and polysubstance abuse.
I was going through the history with this lovely gentleman, and he would just grunt out answers. So I had to ask everything in the form of a question.
Do you have heart problems? grunt
Do you have any kidney problems? no grunt-i assume that is no.
Do you have diabetes? grunt
Do you have high blood pressure? Pt all of a sudden gets very mad, sits upright in bed and starts to scream at me for "how dare I assume that all black men had diabetes and blood pressure problems" and how "racist" I was--then proceeded to make quite a scene.

 

[docB]

I was working a medical student rotation at an extremely busy county hospital. Halfway into my shift, this patient, a 50ish African-American male, who was admitted, for one of many things, severe CHF, uncontrolled DM, and polysubstance abuse.
I was going through the history with this lovely gentleman, and he would just grunt out answers. So I had to ask everything in the form of a question.
Do you have heart problems? grunt
Do you have any kidney problems? no grunt-i assume that is no.
Do you have diabetes? grunt
Do you have high blood pressure? Pt all of a sudden gets very mad, sits upright in bed and starts to scream at me for "how dare I assume that all black men had diabetes and blood pressure problems" and how "racist" I was--then proceeded to make quite a scene.

I had this exact thing happen to me. During the history I said, "I assume you have diabetes and high blood pressure." and the guy went ballistic. "You racist, cracker, MF. So you think all blacks have diabetes and high blood?" I said, "No. I think everyone that takes insulin and toprol, like it says in your chart does though." At that point he quit yelling but he was still pissed. I'm not sure why.

 

[lurkerboy]

I see you are in med school. You'll begin to see that in internal medicine and emergency medicine, you'll feel like this is 2/3 of the patients you'll see at any VA hospital or inner-city hospital

this one takes some sort of cake guys. i don't know what i learned from her, other than some people are just unbelievablely stupid.

44 y/o frequent flier. previously diagnosised CAD... BUT has refused to get cathed (i don't know why they didn't do it at the same time as the angiogram either). lives on a diet of fast food and cigarettes and comes to the ED several times a month complaining of severe chest pain. obviously this isn't someone you can just let walk out the door, seeing as how she could have an AMI at any time. she's openly non-compliant with her meds (she can't afford them... wouldn't want to take away from her big mac's and cigarettes), and says if you try to admit her she'll sign out AMA (she's done so many times before... as soon as she gets moved onto the floor she bolts). however, she demands that you treat her chest pain. 20mg's of MS (that's right, 20... it takes a lot when you weight 350lbs) she's getting "some" relief but still having chest pain. the best we've ever been able to do is get the pharmacy to fill some of her meds for free and have her sign out ama from the ED. I haven't seen heard anything about her in awhile and honestly i don't know if that's because she got tired of us being rude to her or if she finally died.

this patient =

 

[flighterdoc]

I had this exact thing happen to me. During the history I said, "I assume you have diabetes and high blood pressure." and the guy went ballistic. "You racist, cracker, MF. So you think all blacks have diabetes and high blood?" I said, "No. I think everyone that takes insulin and toprol, like it says in your chart does though." At that point he quit yelling but he was still pissed. I'm not sure why.

Hmm... Maybe you should have phrased it a bit differently: So, Mr x, I see you're taking insulin and toprol - for diabetes and HTN?

The "I assume..." is probably what set him off.

Which is why a preload of Haldol is always a good thing to have in your coat.

 

[MoosePilot]

I had this exact thing happen to me. During the history I said, "I assume you have diabetes and high blood pressure." and the guy went ballistic. "You racist, cracker, MF. So you think all blacks have diabetes and high blood?" I said, "No. I think everyone that takes insulin and toprol, like it says in your chart does though." At that point he quit yelling but he was still pissed. I'm not sure why.

So do you still have to treat the patient if he's verbally assaulting you? What's the cutoff from when you have to deal with a little flack and when you get to get some distance from the scary nutjob?

 

[Sessamoid]

So do you still have to treat the patient if he's verbally assaulting you? What's the cutoff from when you have to deal with a little flack and when you get to get some distance from the scary nutjob?

If he has an emergency medical condition, yes you still have to treat him. Behavior like that tends to accelerate my opinion that the patient can't be sick enough to have an emergency medical condition though. I had one of those last night. Being an *sshole isn't a medical emergency, despite what the patient's family might think.

 

[IdiotBoxen]

Went for a mini-holiday. And what greeted me on my return?

Patient was 16 year old female. History from her GP indicates that she's been having mild bleeding between periods. GP also notes that mother had early hysterectomy from endometerial cancer.

So, I decide to a pelvic. Her vagina has scratch marks all over it, from vulva to cervix practically. Some of them look freshly done. Not a good look at all. So, i'm thinking abuse at this point... There are also some marks around the vulva that seem to confirm my thinking.

I question the patient about these. And then comes the answer... This young girl has been using a toothbrush to 'clean' her vagina. Apparently she didn't get the linkage between this 'cleaning' and the bleeding.

Why this cleaning you ask? Her mother has apparently managed to convince her that her vagina is very dirty and she must keep it clean or she'll get cancer like she did.

*sobs*

 

[MoosePilot]

 

[Febrifuge]

Holy crap.

So there's a discussion that needs to happen between the mom and someone. NOW.

(I nominate the GP.)

 

[docB]

If you are planning to huff carburator cleaner try to get the stuff that's just hydrocarbons. You'll get a hydrocarbon pneumonitis but that's about it. If you pick the stuff that has methanol in it you'll get to experience the miracle of dialysis.

 

[leviathan]

Holy crap.

So there's a discussion that needs to happen between the mom and someone. NOW.

(I nominate the GP.)

Yes, and that would be, "Don't give any advice to your child on anything...ever!"

Similarly to the daugther, "Don't receive any advice from your mother on anything...ever!"

 

[Mediculous]

Yes, and that would be, "Don't give any advice to your child on anything...ever!"

Similarly to the daugther, "Don't receive any advice from your mother on anything...ever!"

I presume the comic-book guy from The Simpsons is giving the talk, right?

 

[Sessamoid]

If you deem it too cold outside to have a barbeque (and forcrissakes, it's LA so how cold can it be?), then you probably shouldn't decide to have one indoors instead, unless building up to a carbon monoxide level of 25 is your idea of a good cookout.

 

[funkless]

Yes, and that would be, "Don't give any advice to your child on anything...ever!"

Similarly to the daugther, "Don't receive any advice from your mother on anything...ever!"

Also, someone should buy the girl a clean toothbrush. Her breath must smell awful.

 

[leviathan]

I presume the comic-book guy from The Simpsons is giving the talk, right?

Preferrably.

 

[docB]

Also, someone should buy the girl a clean toothbrush. Her breath must smell awful.

UGG! What a totally inappropriate, tasteless and vile comment! I love it!

 

[funkless]

UGG! What a totally inappropriate, tasteless and vile comment! I love it!

Holdin' out for EM, baby. See you in 3.5 years.

--Funkless

 

[8744]

Holdin' out for EM, baby. See you in 3.5 years.

--Funkless

I am gratified to see myself quoted in your signature line.

Sincerely,

P. Bear

Interviewed/Interviewing at:
Baton Rouge
Temple, Texas
El Paso
Little Rock
Shreveport, Louisiana
Morgantown, West Virginia
Omaha, Nebraska
Waiting List at Louisville

 

[Nof55]

If you are a patient who comes into my ED with a penis fracture realize NO ONE believes your story that you did it simply while trying to pee. And yes they really are going to have to do "nasty things" like degloving for the urologist to be able to repair it so you will be able to use it again. And yes you do do have to listen to the explanation by the urologist... it's called informed consent.

 

[pinbor1]

If you are going to swallow razor blades...thanks for being nice enough to tell us that it was 2 and you did it for drugs. A number and a motive make my job easier.

ha! how's this for follow up in the ER. I saw this guy about 1 mos after he was discharged. Came back to the ED and told me that he was at an outside ED and d/c'd for chest pain (hmm maybe secondary to the crack). Well he BS's me and tells me that the surgeons told him to come back here because there was still a razor that in his stomach from last time that they couldn't find. So I decide to entertain him given that he did have some LUQ tenderness. Sure enought he had another razor there, after confronting him, he admits that he swallowed another razor for $50 more bucks so he could by some crack.

In the words of Rick James "Cocaine is a helluva drug"

 

[Sessamoid]

ha! how's this for follow up in the ER. I saw this guy about 1 mos after he was discharged. Came back to the ED and told me that he was at an outside ED and d/c'd for chest pain (hmm maybe secondary to the crack). Well he BS's me and tells me that the surgeons told him to come back here because there was still a razor that in his stomach from last time that they couldn't find. So I decide to entertain him given that he did have some LUQ tenderness. Sure enought he had another razor there, after confronting him, he admits that he swallowed another razor for $50 more bucks so he could by some crack.

In the words of Rick James "Cocaine is a helluva drug"

It should be legal to let these people suffer the consequences of their actions (unless they can pay for treatment BEFOREHAND).

edit: I just noticed that this thread has more posts than the entire Dermatology forum.

 

[docB]

edit: I just noticed that this thread has more posts than the entire Dermatology forum.

They're too busy counting money to post on internet forums.

If your husband was in an MVA I can explain to you his injuries, his test results and his treatment plan. I can not comment on if the company that rented a car to the woman that hit him should have to give you a free rental car. I will not call the rental car company for you and demand said free car. I will certainly not comment on your assertion that the rental car company should be "extra" liable because they rented a car to a person whose ethnicity you equate with bad driving.

 

[bemused]

I can't believe that I forgot this - I hope none of you are suffering too much for my laxity -

If you spread a thick layer of Vicks Vapor Rub all over your face, it burns. Apparently, it burns reaaaaallly bad. The best treatment we have found for it so far begins with washing it off of your face. Thankfully, this is an intervention that is within the scope of a paramedic, so if you call 911 they can help