Annoying Tidbits

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TrumpetDoc

TrumpetDoc

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You know what I mean...
Those extra pieces of info that patients put that special EMPHASIS on with their tone or facial expressions...Done as if to "scare me" or realize "how serious" their issue is.
1. For me, one that I see pts really try to emphasize is
"I'm hypoglycemic"

The other is "...x...it's the WORST my (specialist) has ever seen!!"

What I find irritating is not the I do, but the way its conveyed. Ugggg
 
Any variation of "....but my body responds differently than most."

Had a well-educated upper class woman tell me "my surgeon told me to return to the clinic 6 weeks after the surgery [hernia repair IIRC] to make sure everything looked ok, but for me that 6 months really means 12 months.

😕
 
I have a high pain tolerance, but this really hurts. These pain meds haven't touched it.

or:

I have a high tolerance of pain meds. It takes a lot to help my pain.

and:

I have a severe case of fibromyalgia.
 
When the patient wont even tell you his or her chief complaint until after they've told you a long, sad story about how all the other doctors they've ever seen really screwed up.
 
Great thread idea. I have a litany of things that drive me batty. Of the top of my head, I really hate it when you begin to take a history and they don't start with the chief complaint, or anything related to the chief complaint, but rather they say some variation of...

"Well I was in the hospital a year and a half ago and I was admitted and I was in a coma for like, eleventeen days."

The statement ends there, and they look at you as if you're supposed to do or have done something about it. I want to scream back - "No, d!ckhead... you're here in the ER today for "ankle pain"... not to discuss your miraculous recovery from whatever calamity befell you that you have no recollection of..... now, lets get down to it... why are you here ?"

Just the other day I had a 350+ pound woman come in for "numbness and tingling in my hands and feet that goes halfway up my arms and legs". Poorly controlled diabetic/hypertensive for god knows how long... but she won't accept that its the diabetic neuropathy that's causing her symptoms. That's what her family doc told her. She came to me today because it CAN'T be that, and NEEDS a CT brain to check for cancer/stroke/other imaginary cause of her symptoms. The "little thing" that killed me was the "I'm a victim of some malady and if you can't tell me why, then you're a bad doctor" mentality that she had. I wanted to scream - "the only thing you're a victim of is your own personal irresponsibility. You can't eat peanut butter and honey sandwiches daily (true story) and expect to stay healthy."
 
Also: People who don't know "why" they've had surgical procedures done. How do you let someone open your abdomen and NOT know the reason why you're undergoing surgery ? I get it if you're MRDD or something else... but the fifty-something year-old female with three scars on her abdomen.... c'mon people... PERSONAL RESPONSIBILITY.
 
RustedFox said:
Also: People who don't know "why" they've had surgical procedures done. How do you let someone open your abdomen and NOT know the reason why you're undergoing surgery ? I get it if you're MRDD or something else... but the fifty-something year-old female with three scars on her abdomen.... c'mon people... PERSONAL RESPONSIBILITY.
Click to expand...

C'mon, you can't expect them to know what drugs they're on or why they were put to sleep.
Also, "it's in my record, go look it up."
 
Dr.McNinja said:
C'mon, you can't expect them to know what drugs they're on or why they were put to sleep.
Also, "it's in my record, go look it up."
Click to expand...

"Go look it up".

Yep, as if it's all on record. Somewhere. Nevermind that you've never been to my facility before. I just go to the "ubiquitous medical record" and get all the answers that I want. I mean, its easy for a doctor just to "go get it" because it was once written down, somewhere.

Also, the attitude of "well, you didn't even read my chart, so you're a bad doctor". Yeah, like I have the time to read thru your 50+ pages of drivel before I see you for the first time.
 
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"it's in the computer"

"I already told other people, why do I have to tell you"

"never had any surgeries"
me-"what is that scar from your chest to your pelvis from"
"oh, I got shot/stabbed"
me: "anything removed?"
"I don't know, I was out of it"

me: "Ever have your gallbladder out?"
pt: "no"....5min later "oh I got my gallbladder out when..."
 
How about the "stare"? Anyone else get this?
You know, right after the exam is done and I'm starting to talk through the problems/thought process...
Ice cold, waiting to pounce on me for not coming up with whatever they "knew" it was it want done.

As if they have the Robert Downey Jr. In Sherlock Holmes pre-fight sequence going on or something.
 
southerndoc said:
My normal body temperature is 98 so 99.5 is a fever for me.
Click to expand...

Oh god how did I forget this one. I hear it alllllllll the time no matter what setting I'm working in.

"I usually run around 97, so 98.9 is a fever for me."
 
southerndoc said:
My normal body temperature is 98 so 99.5 is a fever for me.
Click to expand...

That line gets a rectal temp from me. "well there's plenty of people like that, and the only way to tell if you truly have a fever in these cases is to use a rectal thermometer. In fact, that's probably the best way for you to check your own temperature at home" *bats eyes at patient sweetly*
 
Not telling me you had a positive pregnancy test at home.

Answering negatively to questions about past medical history when you've had multiple MIs, diabetes, or HIV. Especially the HIV. And furthermore, if you have a chronic disease like sickle-cell, HIV, myelodysplastic disorders, or auto-immune: have some idea about where you are in terms of the disease!

You should know your baseline hemoglobin, your last CD4 count (at least approximately) and whether you are on anti-retrovirals (bonus if you know you're taking prophylactic meds and top-shelf if you know their names), and when you last took steroids or are on something that severely depresses the immune system. Same with the parents of asthmatics that can't tell you when the last flare-up was or what they take at home besides "a breathing machine". Ignorance is a luxury of the healthy that you can't afford.
 
I can't stand it when people swear up and down that they can't afford their meds, yet they come in wearing Gucci, Prada etc and bragging about the extravagant vacation that they have planned. Saw a woman last week who was a newly diagnosed diabetic and told me that she needed her dental abscess cured instantly because she was going to Jamaica the next day. Never mind the dental appointment, diabetic education and PCP that was blowing off.
 
I especially love the ones who have some weird neuro-inflammatory **** going on for two years that their PCP, 3 neurologists, and 2 rheumatologists have not figured out, so they arrive at my ED at 2 in the morning because, "It's time for an answer." Oh sure, I'm flattered, but what do you expect to accomplish here that wasn't achievable with 20 outpatient visits, 5 imaging studies, and a pint of bloodwork?
 
Along the lines of the "98.6 is a fever for me"....

... hate the mothers who NEED you to know that their little boy/girl is "special" (this is all of them). This usually includes a painstakingly long description of how early they spoke/ambulated/farted and how "odd" it is that their two ear infections required SEVERAL pediatrician visits (normal follow-up visits) to get under control.
 
Me: have you eaten anything today?
Pt: no not today.

5 minutes pass.

Me: When was the last time you ate?
Pt: well I had a sandwich about an hour ago but I haven't really eaten since yesterday
 
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VienneseWaltz said:
I especially love the ones who have some weird neuro-inflammatory **** going on for two years that their PCP, 3 neurologists, and 2 rheumatologists have not figured out, so they arrive at my ED at 2 in the morning because, "It's time for an answer." Oh sure, I'm flattered, but what do you expect to accomplish here that wasn't achievable with 20 outpatient visits, 5 imaging studies, and a pint of bloodwork?
Click to expand...

You know, I just recently saw one of these, a 17 y/o F. The classic story: an inane symptom set (weight gain, 'fuzzy' thinking, and generalized pain x 9 months), the half a dozen previous appointments with different doctors with lots of tests and imaging, the parent yelling 'I want answers!' at 8 p.m. in the ED, etc.

It turns out the kid had somehow gotten diagnosed with a microscopic pituatary adenoma around the onset of her symptoms and her PCP, an endocrinologist, and a bevy of neurosurgeons had been bouncing her back and forth for her presumed diagnosis, and CTing her head over and over again, without ever checking so much as her blood work to see if her hormones were actually off or to check anything else on the differential for her symptoms. She had gained 90 pounds, had gone from the honor roll to unable to comply with a physical exam, and had gone from a varsity athlete to someone who required a wheelchair. In 9 months.

When we checked her BMP she had a serum sodium of 165. And completely normal levels of every hormone controlled by the pituitary. Sometimes the patient is right, I guess.
 
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Perrotfish said:
You know, I just recently saw one of these, a 17 y/o F. The classic story: an inane symptom set (weight gain, 'fuzzy' thinking, and generalized pain x 9 months), the half a dozen previous appointments with different doctors with lots of tests and imaging, the parent yelling 'I want answers!' at 8 p.m. in the ED, etc.

It turns out the kid had somehow gotten diagnosed with a microscopic pituatary adenoma around the onset of her symptoms and her PCP, an endocrinologist, and a bevy of neurosurgeons had been bouncing her back and forth for her presumed diagnosis, and CTing her head over and over again, without ever checking so much as her blood work to see if her hormones were actually off or to check anything else on the differential for her symptoms. She had gained 90 pounds, had gone from the honor roll to unable to comply with a physical exam, and had gone from a varsity athlete to someone who required a wheelchair. In 9 months.

When we checked her BMP she had a serum sodium of 165. And completely normal levels of every hormone controlled by the pituitary. Sometimes the patient is right, I guess.
Click to expand...

Not even any bloodwork? Really??
Now I know Peds pcps are reluctant to do labs, but I have a hard time with this,,,med school diploma via eBay?
 
Perrotfish said:
You know, I just recently saw one of these, a 17 y/o F. The classic story: an inane symptom set (weight gain, 'fuzzy' thinking, and generalized pain x 9 months), the half a dozen previous appointments with different doctors with lots of tests and imaging, the parent yelling 'I want answers!' at 8 p.m. in the ED, etc.

It turns out the kid had somehow gotten diagnosed with a microscopic pituatary adenoma around the onset of her symptoms and her PCP, an endocrinologist, and a bevy of neurosurgeons had been bouncing her back and forth for her presumed diagnosis, and CTing her head over and over again, without ever checking so much as her blood work to see if her hormones were actually off or to check anything else on the differential for her symptoms. She had gained 90 pounds, had gone from the honor roll to unable to comply with a physical exam, and had gone from a varsity athlete to someone who required a wheelchair. In 9 months.

When we checked her BMP she had a serum sodium of 165. And completely normal levels of every hormone controlled by the pituitary. Sometimes the patient is right, I guess.
Click to expand...

Fortunately, that patient will get a chem 7 in almost every ED in the land.

In the rest of 'em they'll get a chem 12.
 
Annoying - not necessarily the theme of the thread -

How many times the chief complaint and discharge diagnoses are unrelated (chest pain - PID, cold - STD, etc). Also how many times they come in with two unrelated chief complaints (same examples apply).
 
EM2BE said:
Annoying - not necessarily the theme of the thread -

How many times the chief complaint and discharge diagnoses are unrelated (chest pain - PID, cold - STD, etc). Also how many times they come in with two unrelated chief complaints (same examples apply).
Click to expand...

MVC - vaginits
 
TrumpetDoc said:
Not even any bloodwork? Really??
Now I know Peds pcps are reluctant to do labs, but I have a hard time with this,,,med school diploma via eBay?
Click to expand...

I guess they did a CT of her head early on. Maybe she had some kind of visual deficit as an early symptom? Once they saw that prolactinoma they just fixated.

It wasn't no blood work, BTW. They had done a serum prolactin level almost weekly. When it was normal every time they assumed they had fixed her, and ignored all of her other progressing symptoms and didn't do any other tests. It also wasn't just a PCP: this girl was bouncing back and forth between a PCP and a pediatric endocrinologist and had had appointments with multiple neurosurgeons.
 
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my fourth cousin is CCU nurse, so I know all about cardiac testing

HH
 
Hamhock said:
my fourth cousin is CCU nurse, so I know all about cardiac testing

HH
Click to expand...

Oh God I hate that one. I frequently have them on the phone and often trying to get me on the phone with their impromptu remote medical advisors. Invariably they have a minimal understanding of the limitations of testing, e.g. "Did you get an EKG to rule out a heart attack?" or "You know it's not a stroke because you got a CT."

I understand when nurses without any ED experience say crap like that but I run into it from doctors too. I think that's because many primaries have gotten so accustomed to dumping on the ER they don't even remember what an actual work up looks like. "Well your EKG looks ok to me but you better go on over to the ER so they can do one. They have better equipment and if your EKG looks good there they'll let you go home."😡

Just last week I had a guy who was visiting from elsewhere. He was exercising and his AICD shocked him for sinus tach. His trop started low and rose. I wanted to admit him and my cardiologist agreed. Here's where it gets really frustrating. A family member calls his cardiologist back home and of course demands that I talk to him. He demands I discharge the patient because this is all expected with the shocks. I tell him I think we should keep him at least until the troponins plateau. He says it's not necessary. Family then informs me that I am to d/c the patient immediately or they will call my CEO and must be discharged, not go AMA, because they don't want insurance to refuse the bill (another common nurse misconception). She says it's not AMA because it's on the advice of her doctor back home. Whatever. Vaya con dios. Documented the threats, discharged per pt's cardiologist, warned patient and wife he may die. Definitely one of those shifts where you leave and need a stiff drink and a hot shower.
 
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The "pause" is what gets me, usually when I ask about diarrhea.

Have you had diarrhea?

*thinking*
*thinking*
*thinking*
*thinking*
*thinking*

A little, I guess.

Yeah, well guess what? If you have to think that long, you don't have diahrrea and I officially don't care about your answer. Swear to God, must be in the way I ask the question but 9 times outta 10 tha tI ask I'll never get a straight up no. Even better is when the pause if followed by a worried or confident "Yes, in June of 2007"

Drives. Me. Crazy.
 
Or when the patient says they had too many BMs to count today, but during a 4 hr stay can't produce a single stool speciman. Also, young people that somehow miss the speciman cup while producing a urine sample.
 
Those that think cathing a child is somehow "torture" or "rape". And not just parents. Nurses, techs, etc.

And I'm not sure how often the rest of you have it, but at least twice I've had an angry dad tell me to effectively assault his daughter because he knows she was having sex and he wants proof.
 
southerndoc said:
Hate it when patient's tell me that I need to check a serum HCG on them because they've been pregnant n number of times and it only showed up on a blood test and not in the urine.
Click to expand...

Had a patient tell me that...and actually be right for once.
 
I hate the exagerated descriptions of vaginal bleeding. And the weird paranoia about clots.

Patient: "I started my period and then it got really bad..... I HAD A CLOT COME OUT!"

95% of the time, when you do the pelvic, there is a mild amount of bleeding, consistent with a mild to moderate period. Amazingly, woman who have been "pouring blood for weeks" have normal hemoglobins 99% of the time.

I also hate the exagerated Family Histories.

Me: Do you have any medical problems in your Mom, Dad, Brothers or Sisters?
Patient: Slaps their forehead, giggles, gives meaningful look to family member and says, "Oh man, what don't we have, huh? Strokes, heart attacks, cancers of every kind, diabetes, etc. "
Me: OK, what illnesses do your siblings have?
Patient: None, they are all healthy
Me: Is your Mom alive?
Patient: Yes
Me: What medical problems does she have?
Patient: Nothing really
Me: Does your Dad have any medical problems?
Patient: Not really
Me: So those people with all the medical problems are your 80 year old grandparents and you are 30?
Patient: Yes
Me thinking: "You idiot, why did you just waste 30 seconds of my life. I'm never asking another family history question again."
 
Jarabacoa said:
Me thinking: "You idiot, why did you just waste 30 seconds of my life. I'm never asking another family history question again."
Click to expand...

Dude, you just gave a heart attack to those Disney style patient relations consultants. Well done.
 
How about this??? Not a pt thing but boils my blood.

Let's pay no never mind to what is IMPORTANT in the triage hx....
I'll have NOTHING filled out under pmhx, PMD, etc...
But the " ever have a reaction to anesthesia, safe at home, ever have a blood transfusion" etc!!!!!
I realize the hospital needs this worthless info, but NOT in place of needed triage info!!

If I need to sedate them or transfuse them, I'll consent them myself😉
 
I also hate the 300 lb ladies who obsess about their diet and then make statements like, "I never eat anything non-organic or unhealthy." They go on for 3 minutes detailing their supplements, their avoidance of red die number 2, and their shunning of all types of sugar. They go on to ask you advice on what to eat to not get diverticulitis again. As you look at this fatty, you think, "You ate at least 3000 calories a day for a couple of decades to get to be your size and you want me to believe you eat healthy?"

Of course, if you are obsessing about diet in the ER, you most certainly don't have a real emergency, and I really don't care about giving you accurate advice about something I don't really care about, study or want to know about. I want a fluorescent sign behind me that I can activate at times with a clap.

Me: Clap.
Sign: "This is an Emergency Department. That is not an emergent question...shut yer hole!"
 
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I love the endless variations and lengthy diatribes on the severity of pain. If they only knew that all they had to say was "It's severe" or "It's mild". That's truly all I care about, and all I write down in the chart. Your work-up and treatment is no different if you explain for 3 minutes just how severe that pain was than if you would just say "It hurts really bad doc." In the end, I write down "severe" pain. In fact, if it's the chief complaint, I nearly always write down "severe", because why come to the ED if the patient doesn't judge it to be severe?
 
ActiveDutyMD said:
I love the endless variations and lengthy diatribes on the severity of pain. If they only knew that all they had to say was "It's severe" or "It's mild". That's truly all I care about, and all I write down in the chart. Your work-up and treatment is no different if you explain for 3 minutes just how severe that pain was than if you would just say "It hurts really bad doc." In the end, I write down "severe" pain. In fact, if it's the chief complaint, I nearly always write down "severe", because why come to the ED if the patient doesn't judge it to be severe?
Click to expand...

This nonsense is now being picked up by not just the nurses (I know they are mandated to documented the 'new' vital signs like pain) but now residents!

It drives me nuts to hear presentations from residents (including EM residents!) that include phrases like: "Pain was 7 out of 10, but after 4mg of morphine is now 3 out of 10".

It kills me.

HH
 
Here's one I heard this week from a guy transferred to us who was getting acyclovir from the other jail. I do a therapeutic interchange with valacyclovir cause we like meds that you give bid instead of 5x a day. Nurse comes to me saying the patient was refusing the Valtrex and was getting abusive, so she got me to talk to him.

Pt: "Why did you SWITCH MY MEDS? I'm being treated by an HIV specialist. NOBODY should touch my meds!!!!"

Me: "You were on acyclovir. This one is val-acyclovir" I emphasize the similarity of the names; this works ok, usually. "They're practically the same thing."

Pt: "I know my body better than anyone!! NOBODY should touch my meds!!!"

As drs, do you ever get the "I know my body better..." thing? When I hear that, I know it's an argument I can't win.
 
Pt on abx complains that he's getting a rash when he's out in the sun.
I recommend staying out of the sun.
He informs me that his work requires him to be outside.
I suggest long sleeves and a hat.
He replies "that will make me sweat like a Hebrew slave".
I give up.

This is just another variation on the common phenomena of patients with mild complaints who come to the ED and refuse four different drug classes, because they've tried 'em all & the side effects were worse that the disease.
I guess your primary complaint must not be bothering you that much then, huh?
 
WilcoWorld said:
This is just another variation on the common phenomena of patients with mild complaints who come to the ED and refuse four different drug classes, because they've tried 'em all & the side effects were worse that the disease.
I guess your primary complaint must not be bothering you that much then, huh?
Click to expand...

Or when they seem to think that a (real or b.s.) PCN allergy means they are allergic to all antibiotics and insist that the three non-PCN abx you then try to prescribe are in fact PCNs...
 
WilcoWorld said:
Pt on abx complains that he's getting a rash when he's out in the sun.
I recommend staying out of the sun.
He informs me that his work requires him to be outside.
I suggest long sleeves and a hat.
He replies "that will make me sweat like a Hebrew slave".
I give up.

This is just another variation on the common phenomena of patients with mild complaints who come to the ED and refuse four different drug classes, because they've tried 'em all & the side effects were worse that the disease.
I guess your primary complaint must not be bothering you that much then, huh?
Click to expand...

This is a pet peeve of mine. I have come to realize that the problem is that patients do not understand, have never been told, that when they are allergic to the first line treatment they will be getting a less effective treatment. They all seem to think that all antibiotics, pain meds, etc. are completely interchangeable.
 
"As Doctors... do you get the 'I know my body better than anyone' thing ?"
(Sorry, lost the quotes)


Yep... all the time, and it drives me crazy. I want to grab them and scream -

"Oh, you know your body better than anyone? Good, then you can go fix yourself, then. What ARE you doing here, for chrissakes? In reality - you don't know d!ck about 'your' body, or 'the' body at all, for that matter... otherwise, you'd have my knowledge and skill set... and you don't, now do you."
 
My plan of action...

For the "I have a high pain threshhold and this really hurts". I quickly respond.. "Oh thats really good. So do I and that means you are really sensitive to pain meds, I took 1 vicodin once and felt like I drank a gallon of Vodka (I am 6'2 250)". This quickly lets em know I think their pain is serious when I offer them 2.

The my normal temp is 95.8, drives me nuts.. I just ignore..

The other thing that drives me nuts.. The Hypertension checks.. My BP is usually between 120-122.. today it was 130, thats abnormal. Me: Anything else bothering you? Them: No but its never that high.

A quick dispo...
 
EctopicFetus said:
My plan of action...

For the "I have a high pain threshhold and this really hurts". I quickly respond.. "Oh thats really good. So do I and that means you are really sensitive to pain meds, I took 1 vicodin once and felt like I drank a gallon of Vodka (I am 6'2 250)". This quickly lets em know I think their pain is serious when I offer them 2.

The my normal temp is 95.8, drives me nuts.. I just ignore..

The other thing that drives me nuts.. The Hypertension checks.. My BP is usually between 120-122.. today it was 130, thats abnormal. Me: Anything else bothering you? Them: No but its never that high.

A quick dispo...
Click to expand...

Then comes my secondary pet-peeve when they look at you with the 'head slightly tilted to the side, blank stare, awkard silence, quizzical' expression where you can almost make out a few synapses just trying to cross from one side of their head to the other . . .
 
How about being forced to give anti hypertensives just so a patient can meet arbitrary goals for the floors.

I've started getting on the phone directly with the floor nurse to let them know the sbp was 230 and is now 170 or whatever it is and that it is unreasonable to drop them further to satisfy arbitrary requirements.

Sometimes that works and sometime all I get is more flack.
 
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