Consults- Memorable/Dismal/Ridiculous/Unique

[LucidSplash]

None of the CTs or MRIs over the 4 days showed the TMJ subluxation?

Probably they were only of the brain.

I swear I'm not THAT old but it seems like no one does even a focused physical exam half the time unless told to? We were trying to figure out if one of our patients had a tissue or mechanical valve (because we wanted to take her off warfarin and put her on a NOAC if possible) but neither she nor her family knew, they didn't remember where she had it done/couldn't get records. Interns suggested getting a CT scan to see if it was metal or not metal.

Me: Did you listen to her with a stethoscope? You'll know if its mechanical.

Interns: Blank stare.

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[HighPriest]

Hey, it WAS an ENT problem, then!

I’d have sent him to oral surgery.

 

[dpmd]

Probably they were only of the brain.

I swear I'm not THAT old but it seems like no one does even a focused physical exam half the time unless told to? We were trying to figure out if one of our patients had a tissue or mechanical valve (because we wanted to take her off warfarin and put her on a NOAC if possible) but neither she nor her family knew, they didn't remember where she had it done/couldn't get records. Interns suggested getting a CT scan to see if it was metal or not metal.

Me: Did you listen to her with a stethoscope? You'll know if its mechanical.

Interns: Blank stare.

Did you then click your pen at them to demonstrate

 

[LucidSplash]

Did you then click your pen at them to demonstrate

Possibly.

 

[evilbooyaa]

Probably they were only of the brain.

I swear I'm not THAT old but it seems like no one does even a focused physical exam half the time unless told to? We were trying to figure out if one of our patients had a tissue or mechanical valve (because we wanted to take her off warfarin and put her on a NOAC if possible) but neither she nor her family knew, they didn't remember where she had it done/couldn't get records. Interns suggested getting a CT scan to see if it was metal or not metal.

Me: Did you listen to her with a stethoscope? You'll know if its mechanical.

Interns: Blank stare.

Clearly only way to know is to get an MRI.

That being said, I've never heard a mechanical heart valve, so I wouldn't have known that.

 

[dpmd]

Clearly only way to know is to get an MRI.

That being said, I've never heard a mechanical heart valve, so I wouldn't have known that.

You don't have to have heard one before. Simply auscultating the heart would have led to hearing such an unusual sound that it should have been remarked on. At which point someone else hopefully had heard one or been told the pen click thing.

 

[Dr.LeoSpaceman]

Why listen to lungs when I can just get a chest x-ray?

Why listen to the heart when I can get an echo?

Why did an abdominal exam when I can just get a CT?

I kid...sort of. Though I do get some morbid enjoyment out of catching juniors/med students for not doing an abdominal exam.

Me: "What surgeries have they had?"
Junior: "They said they haven't had any."
Me: "Well it looks like we've got a case report on our hands, because they seemed to have a congenital laparotomy scar."

 

[LucidSplash]

Why listen to lungs when I can just get a chest x-ray?

Why listen to the heart when I can get an echo?

Why did an abdominal exam when I can just get a CT?

I kid...sort of. Though I do get some morbid enjoyment out of catching juniors/med students for not doing an abdominal exam.

Me: "What surgeries have they had?"
Junior: "They said they haven't had any."
Me: "Well it looks like we've got a case report on our hands, because they seemed to have a congenital laparotomy scar."

I have seen many a congenital sternotomy scar.

 

[Raryn]

Why listen to lungs when I can just get a chest x-ray?

Why listen to the heart when I can get an echo?

Why did an abdominal exam when I can just get a CT?

I kid...sort of. Though I do get some morbid enjoyment out of catching juniors/med students for not doing an abdominal exam.

Me: "What surgeries have they had?"
Junior: "They said they haven't had any."
Me: "Well it looks like we've got a case report on our hands, because they seemed to have a congenital laparotomy scar."

"What medical conditions does the patient have?"

"Patient denies all medical conditions".

"What medications does the patient take?"

"Lisinopril, hydrochlorothiazide, metformin, atorvastatin, three inhalers, two forms of eye drops, and a partridge in a pear tree"

 

[OtoHNS]

It was indeed. Now, I will say that the patient was calling his symptoms "hoarseness, or a change in voice" but if you actually ask him to describe what he's experiencing it was dysarthria, slowing speech, and word finding difficulty. So I have no doubt the PCP heard hoarseness and said "Ok, here's some flonase, now GTFO." But, that's also how you miss a progressing neurologic condition. Patient histories. That's why you spend 4 years learning how to take them.

The fact is the patient didn't know what hoarseness was. Which seems surprising, but it's not his job to know that.

If only all patients came in and said "hey, doc, I think I have psuedobulbar palsy," and you could just rely on that. Boy, that'd make things easier. Almost like you wouldn't need doctors at all.

My favorite part was when the patient said "I don't think I have postnasal drip," and I said "Me either, buddy. Me either."

I'm surprised this PCP didn't hallucinate some "fluid behind the eardrum" and prescribe amoxicillin, just because.

 

[VisionaryTics]

I'm surprised this PCP didn't hallucinate some "fluid behind the eardrum" and prescribe amoxicillin, just because.

Patient in clinic today sent for persistent fluid behind drum, according to PCP.

Or rather, there was a persistent hearing aid insert in the canal. The big black rubber thing. The thing you should've noticed when his chief complaint to you three months ago was "I lost my hearing aid part in my ear".

 

[OtoHNS]

Patient in clinic today sent for persistent fluid behind drum, according to PCP.

Or rather, there was a persistent hearing aid insert in the canal. The big black rubber thing. The thing you should've noticed when his chief complaint to you three months ago was "I lost my hearing aid part in my ear".

But the light reflex was absent!

 

[Pir8DeacDoc]

I'm loving that the rest of the otos on here deal with the same crap I do.

 

[310prolene]

Probably they were only of the brain.

I swear I'm not THAT old but it seems like no one does even a focused physical exam half the time unless told to? We were trying to figure out if one of our patients had a tissue or mechanical valve (because we wanted to take her off warfarin and put her on a NOAC if possible) but neither she nor her family knew, they didn't remember where she had it done/couldn't get records. Interns suggested getting a CT scan to see if it was metal or not metal.

Me: Did you listen to her with a stethoscope? You'll know if its mechanical.

Interns: Blank stare.

I take a lot of face trauma call. While a face ct is ideal, I have been able to identify a tmj dislocation on ct brain. Similarly, I have seen radiology make the call on a ct brain, which prompted the ED to order a formal ct max face.

While I find most people in the hospital to be lost when it comes to craniomaxillofacial pathology, someone sitting on the floor for 4 days with bilateral TMJ dislocations is a new low.

 

[tkim]

Probably they were only of the brain.

I swear I'm not THAT old but it seems like no one does even a focused physical exam half the time unless told to? We were trying to figure out if one of our patients had a tissue or mechanical valve (because we wanted to take her off warfarin and put her on a NOAC if possible) but neither she nor her family knew, they didn't remember where she had it done/couldn't get records. Interns suggested getting a CT scan to see if it was metal or not metal.

Me: Did you listen to her with a stethoscope? You'll know if its mechanical.

Interns: Blank stare.

"Since his exile, more than thirty years before, the King had made gambling a career. Poker was his work. Recently, however, he had had a taste of open-heart surgery. A major valve had been removed and replaced with a Teflon substitute. The artificial valve functioned efficiently, but it made a metallic noise as it opened and shut. When he was excited, everyone in the room knew it. Due to the audible sound of his heart, he was no longer able to practice poker, a game with necessary concealments and bluffs. “Jesus,” he said. “When I draw a good hand, I sound like a Tupperware party.” He spent his hours watching sports on television, pining for the good old days when he could have ordered referees and umpires to the garrote." - Tom Robbins, Still Life With Woodpecker

 

[HighPriest]

"What medical conditions does the patient have?"

"Patient denies all medical conditions".

"What medications does the patient take?"

"Lisinopril, hydrochlorothiazide, metformin, atorvastatin, three inhalers, two forms of eye drops, and a partridge in a pear tree"

i USED to have high blood pressure, but the medicine fixes that.

 

[HighPriest]

Patient in clinic today sent for persistent fluid behind drum, according to PCP.

Or rather, there was a persistent hearing aid insert in the canal. The big black rubber thing. The thing you should've noticed when his chief complaint to you three months ago was "I lost my hearing aid part in my ear".

I have completely abandoned the idea that anyone in a primary care setting knows what the inside of an ear is supposed to look like. No matter what the referral note says, it’s totally unreliable. Mass in the canal? 80% likely it’s nothing, 19% likely its wax, .99999% likely its a foreign body, and .00001% likely its a mass because even a broken clock....

Add in to that the number of times I see a kid on their 5th course of antibiotics for an ear infection, the symptoms of which are “constipation and upset stomach” or some other such nonsense. Happens every week at least.

 

[deleted547339]

"What medical conditions does the patient have?"

"Patient denies all medical conditions".

"What medications does the patient take?"

"Lisinopril, hydrochlorothiazide, metformin, atorvastatin, three inhalers, two forms of eye drops, and a partridge in a pear tree"

I hear that every day in the ER. “I don’t have the sugars, the pressures or high cholestorol - I take medicine for that. And my hearts fine, my heart doctor put in 5 stents and fixed all that.”

 

[vhawk]

I got a consult once for a patient being mute. I was like "that's not an ENT problem, if he's not speaking, it's a neurology problem". They said he was just sitting there with his mouth open, fully conscious, but wouldn't talk.

I go and see the patient and he's got bilateral TMJ subluxations. I pop him back into place in front of his family, the primary doctor, and nurses and he immediately starts talking. He had been in the hospital for 4 days getting a million dollar workup including MRI, carotid dopplers, CT scans, psych consult.

Did Highway to the Danger Zone immediately start playing on the overhead while you put on your aviators, chewed on a toothpick and said "all in a days work" and walked out in slow motion?

Because thats what I would have done

 

[vhawk]

Why listen to lungs when I can just get a chest x-ray?

Why listen to the heart when I can get an echo?

Why did an abdominal exam when I can just get a CT?

I kid...sort of. Though I do get some morbid enjoyment out of catching juniors/med students for not doing an abdominal exam.

Me: "What surgeries have they had?"
Junior: "They said they haven't had any."
Me: "Well it looks like we've got a case report on our hands, because they seemed to have a congenital laparotomy scar."

Thats the one time when I'm happy to humiliate the junior residents because quite frankly its a mistake you should really only make once. If you tell me that the patient has a virgin abdomen, and I lift up the gown and see a roadmap, this will be the last time that either a) you make that mistake or b) I listen to you calling me with a consult.

 

[BigRedBeta]

I have completely abandoned the idea that anyone in a primary care setting knows what the inside of an ear is supposed to look like. No matter what the referral note says, it’s totally unreliable. Mass in the canal? 80% likely it’s nothing, 19% likely its wax, .99999% likely its a foreign body, and .00001% likely its a mass because even a broken clock...

Summer between college graduation and M1 year, I ruptured my ear drum. I complained to my PCP at the time, he looked, said "looks good to me". Had an appointment with my allergist 20 minutes later who goes "how long have you had this perforated ear drum?"



As for recent memorable consults...I was doing locums in a small PICU a few months back, where I got consulted by anesthesia to intubate a 7 week old on the way to the OR for a pyloromyotomy. I wasn't bothered by having to do it, but I certainly wondered who my backup was if I ran into a difficult airway...

 

[Winged Scapula]

Summer between college graduation and M1 year, I ruptured my ear drum. I complained to my PCP at the time, he looked, said "looks good to me". Had an appointment with my allergist 20 minutes later who goes "how long have you had this perforated ear drum?"



As for recent memorable consults...I was doing locums in a small PICU a few months back, where I got consulted by anesthesia to intubate a 7 week old on the way to the OR for a pyloromyotomy. I wasn't bothered by having to do it, but I certainly wondered who my backup was if I ran into a difficult airway...

CRNA or anesthesiologist?

 

[BigRedBeta]

CRNA or anesthesiologist?

Anesthesiologist

It is decent hospital in a smaller town that's about 2.5 hours from a bunch of major centers, big enough though that it keeps straight forward stuff. They had created a group of anesthesiologists who were the "peds group", but that only meant that the non-peds people got even less exposure. My view was that the anesthesiologist probably had double digit intubations this week, whereas middle of summer in the PICU meant it had probably been a month since my last tube, but if you weren't comfortable with kids, maybe you shouldn't be in the call schedule.

 

[Pir8DeacDoc]

Did the kid have some facial anomaly like Pierre Robin that made anesthesia nervous? Because otherwise that's ridiculous.

 

[Southpaw]

Anesthesiologist

It is decent hospital in a smaller town that's about 2.5 hours from a bunch of major centers, big enough though that it keeps straight forward stuff. They had created a group of anesthesiologists who were the "peds group", but that only meant that the non-peds people got even less exposure. My view was that the anesthesiologist probably had double digit intubations this week, whereas middle of summer in the PICU meant it had probably been a month since my last tube, but if you weren't comfortable with kids, maybe you shouldn't be in the call schedule.

Yeah, they’re either just lazy or a bad outcome waiting to happen. Maybe both!

 

[MoMoGesiologist]

Summer between college graduation and M1 year, I ruptured my ear drum. I complained to my PCP at the time, he looked, said "looks good to me". Had an appointment with my allergist 20 minutes later who goes "how long have you had this perforated ear drum?"



As for recent memorable consults...I was doing locums in a small PICU a few months back, where I got consulted by anesthesia to intubate a 7 week old on the way to the OR for a pyloromyotomy. I wasn't bothered by having to do it, but I certainly wondered who my backup was if I ran into a difficult airway...

Are you ENT? Usually the only time anesthesia consults for airways is when it may be difficult and we want ENT input/help/back up... at least that was the system in my residency.

Then again I guess if you hadn't intubated a kid in a couple months, maybe it makes sense to get someone else? How is this person on call for peds anesthesia!?

 

[Winged Scapula]

Did the kid have some facial anomaly like Pierre Robin that made anesthesia nervous? Because otherwise that's ridiculous.

Exactly.

I understand that there are anesthesiologists who do only Peds, but if you're on call, you'd better be comfortable with whats coming in the door and I'd darn sure expect that the anesthesiologist is better at intubating ANYONE than anyone else.

 

[LucidSplash]

For the love of GOD. There is no such thing as “maintenance fluid deficiency.” I can’t seem to get out PACU nurses to understand that just because someone is not yet sipping ginger ale after a debridement, does not mean they need to be on fluids. Everytime I say I don’t want anymore fluids, they ask what the patient will do until they wake up.

I don’t know Karen. Probably the same thing you do at night when you sleep without an IV.

Half my patients have CHF, they got fluids all night while NPO and I stop them on the postop orders. They are not going to die in the hour until they wake up once they get back to the floor.

End rant.

 

[Psai]

For the love of GOD. There is no such thing as “maintenance fluid deficiency.” I can’t seem to get out PACU nurses to understand that just because someone is not yet sipping ginger ale after a debridement, does not mean they need to be on fluids. Everytime I say I don’t want anymore fluids, they ask what the patient will do until they wake up.

I don’t know Karen. Probably the same thing you do at night when you sleep without an IV.

Half my patients have CHF, they got fluids all night while NPO and I stop them on the postop orders. They are not going to die in the hour until they wake up once they get back to the floor.

End rant.

This isn't a consult

 

[LucidSplash]

This isn't a consult

I know but I couldn’t find the other miscellaneous complaining thread, the one we haven’t used in awhile. And it was either this or reach through the phone and rip out the nurse’s goozle.

 

[IMGASMD]

I know but I couldn’t find the other miscellaneous complaining thread, the one we haven’t used in awhile. And it was either this or reach through the phone and rip out the nurse’s goozle.

But but but. The patient will be thirsty when they wake up. I am a patient advocate, cannot have that happen!!! /s

Back to your regular programming.

 

[Raryn]

I know but I couldn’t find the other miscellaneous complaining thread, the one we haven’t used in awhile. And it was either this or reach through the phone and rip out the nurse’s goozle.

For the love of GOD. There is no such thing as “maintenance fluid deficiency.” I can’t seem to get out PACU nurses to understand that just because someone is not yet sipping ginger ale after a debridement, does not mean they need to be on fluids. Everytime I say I don’t want anymore fluids, they ask what the patient will do until they wake up.

I don’t know Karen. Probably the same thing you do at night when you sleep without an IV.

Half my patients have CHF, they got fluids all night while NPO and I stop them on the postop orders. They are not going to die in the hour until they wake up once they get back to the floor.

End rant.

If you're in your last year of fellowship and ask nicely, @Winged Scapula might let you in to the practicing physician forum - we have a venting thread.

 

[ThoracicGuy]

I know but I couldn’t find the other miscellaneous complaining thread, the one we haven’t used in awhile. And it was either this or reach through the phone and rip out the nurse’s goozle.

 

[LucidSplash]

Because that never ends well for a female physician.

See also the pharmacist who called me 3 times this morning arguing that the patient getting thrombolysis should still be on a weight-based heparin gtt becaue she clearly just did not understand what lysis was or that “running heparin through the sheath” is, in fact, systemic heparin.

I’m getting very cranky as a PGY9. I need to fast forward to the end of my fellowship.

 

[LucidSplash]

If you're in your last year of fellowship and ask nicely, @Winged Scapula might let you in to the practicing physician forum - we have a venting thread.

Imma wait til she’s back from Bora Bora. That’s probably when her mood will be the absolute best. Plus I get to continue looking at her vacation pics on FB and dreaming of my future copycat vaycay.

 

[Apollyon]

Imma wait til she’s back from Bora Bora. That’s probably when her mood will be the absolute best. Plus I get to continue looking at her vacation pics on FB and dreaming of my future copycat vaycay.

I was a prelim IM intern when I went to Tahiti, 16 years ago next month! You CAN do it!! (And I didn't get ANY money from family - we wasn't rich AT ALL. It wasn't a gift trip.)

 

[deleted547339]

Because that never ends well for a female physician.

See also the pharmacist who called me 3 times this morning arguing that the patient getting thrombolysis should still be on a weight-based heparin gtt becaue she clearly just did not understand what lysis was or that “running heparin through the sheath” is, in fact, systemic heparin.

I’m getting very cranky as a PGY9. I need to fast forward to the end of my fellowship.

It amazes me how people don’t understand that when heparin is running through something other than a straight IV (sheath, impella, etc), the heparin doesn’t magically disappear.

 

[IMGASMD]

I’m getting very cranky as a PGY9. I need to fast forward to the end of my fellowship.

I am surprised with all that education behind you, you haven’t figured out all these f-ing Noctors are in fact, f-ing stupid.

I just nod and tell them that’s in fact what I ordered. Thank you.

 

[Winged Scapula]

I was a prelim IM intern when I went to Tahiti, 16 years ago next month! You CAN do it!! (And I didn't get ANY money from family - we wasn't rich AT ALL. It wasn't a gift trip.)

Yeah can definitely do it cheaper here, even in Bora Bora (although Tahiti is cheaper), by staying at local pensions, cooking for yourself, snorkeling at public beaches, etc. I don't think that's the kind of vacation @LucidSplash is talking about. Most residents would not be able to afford such a holiday on a single income. At least I never could.

Imma wait til she’s back from Bora Bora. That’s probably when her mood will be the absolute best. Plus I get to continue looking at her vacation pics on FB and dreaming of my future copycat vaycay.

You should ask now; once I'm back all this will be a distance memory and I'll be cranky again.

Right now I'm sitting on the deck of my OWB, listening to some Polynesian drums in the distance, belly full of Vanilla Tea and croissants, deciding what to do today. I'm in pretty good mood.

 

[LucidSplash]

Yeah can definitely do it cheaper here, even in Bora Bora (although Tahiti is cheaper), by staying at local pensions, cooking for yourself, snorkeling at public beaches, etc. I don't think that's the kind of vacation @LucidSplash is talking about. Most residents would not be able to afford such a holiday on a single income. At least I never could.



You should ask now; once I'm back all this will be a distance memory and I'll be cranky again.

Right now I'm sitting on the deck of my OWB, listening to some Polynesian drums in the distance, belly full of Vanilla Tea and croissants, deciding what to do today. I'm in pretty good mood.

Definitely not what I’m envisioning. I can be satisfied with cheap trips to Mexico on the budget plan. After I pay off debt and take care of some family matters once I’m an attending, I’m dreaming of a @Winged Scapula style vacation with overwater huts etc. This is a goal for after paying off debt, passing vascular boards, finally “making it” kind of vaycay. Am I fangirling and idealizing on WS lifestyle? Maybe a little bit but you do what you have to do when the end of training is so close you can taste it but you still have to get through one more NY winter.

And @Winged Scapula I try not to ignore good advice so pretty pretty please with a cherry on top? I promise to behave. Mostly.

 

[Winged Scapula]

Definitely not what I’m envisioning. I can be satisfied with cheap trips to Mexico on the budget plan. After I pay off debt and take care of some family matters once I’m an attending, I’m dreaming of a @Winged Scapula style vacation with overwater huts etc. This is a goal for after paying off debt, passing vascular boards, finally “making it” kind of vaycay. Am I fangirling and idealizing on WS lifestyle? Maybe a little bit but you do what you have to do when the end of training is so close you can taste it but you still have to get through one more NY winter.

Awww...I thought we were going next year when you were done!

Its ok to "Fangirl": I had an attending whom I did the same thing to. He owned a home in Jackson Hole, was alway vacationing somewhere cool and although I went on several overseas trips as a resident, I could never afford this kind of luxury (or even dream of it. I didn't grow up in a family of vacationers. Vacation was visiting family, not going to an exotic location). So I was always asking him for pictures of his trips.

And @Winged Scapula I try not to ignore good advice so pretty pretty please with a cherry on top? I promise to behave. Mostly.

Ok, I'll see what I can do but you have to behave yourself!

 

[smq123]

Clearly only way to know is to get an MRI.

That being said, I've never heard a mechanical heart valve, so I wouldn't have known that.

It sounds like the second hand of a very loud analog watch. This may no longer be applicable to a new generation that is used to looking at a cellphone to tell time, but anyway....

You don't even need a stethoscope. I had a patient who had rheumatic fever as a child, and had a mechanical valve. If the room was quiet enough, I could tell if he was in a-fib, even from a few feet away.

Why listen to lungs when I can just get a chest x-ray?

Why listen to the heart when I can get an echo?

Why did an abdominal exam when I can just get a CT?

Part of the issue is that patients are accustomed to this too.

I had a patient come in for a referral for a pelvic ultrasound to see if her IUD was "in the right place."

I told her that she doesn't need an ultrasound; I could do a speculum exam and tell her in less than 2 minutes if the IUD was in the right place or not.

She looked FREAKED out, like I was some kind of pervert. "My GYN, my REAL DOCTOR, told me that I had to come back to his office so that he could check an ultrasound and see if the IUD is in the right place or not." I didn't know how to tell her that he was probably recommending this to milk an extra charge for an in-office ultrasound out of her insurance, so I just gave her the referral and told her to have a nice day.

 

[dpmd]

It sounds like the second hand of a very loud analog watch. This may no longer be applicable to a new generation that is used to looking at a cellphone to tell time, but anyway....

You don't even need a stethoscope. I had a patient who had rheumatic fever as a child, and had a mechanical valve. If the room was quiet enough, I could tell if he was in a-fib, even from a few feet away.



Part of the issue is that patients are accustomed to this too.

I had a patient come in for a referral for a pelvic ultrasound to see if her IUD was "in the right place."

I told her that she doesn't need an ultrasound; I could do a speculum exam and tell her in less than 2 minutes if the IUD was in the right place or not.

She looked FREAKED out, like I was some kind of pervert. "My GYN, my REAL DOCTOR, told me that I had to come back to his office so that he could check an ultrasound and see if the IUD is in the right place or not." I didn't know how to tell her that he was probably recommending this to milk an extra charge for an in-office ultrasound out of her insurance, so I just gave her the referral and told her to have a nice day.

Why didn't this real doctor request the test himself?

 

[smq123]

Why didn't this real doctor request the test himself?

Insurance issues. Apparently they stopped taking her insurance shortly after the IUD was placed.

The plan was that they would place the IUD, and then follow up with an in-office ultrasound 3 months later. Since they no longer took her insurance, she had to have it done at an outside facility, which requires seeing a PCP, getting a referral, waiting for the referral, scheduling the ultrasound, and then waiting for the results. Whatever, she wants to be dumb, that's her time wasted, not mine.

 

[dpmd]

Insurance issues. Apparently they stopped taking her insurance shortly after the IUD was placed.

The plan was that they would place the IUD, and then follow up with an in-office ultrasound 3 months later. Since they no longer took her insurance, she had to have it done at an outside facility, which requires seeing a PCP, getting a referral, waiting for the referral, scheduling the ultrasound, and then waiting for the results. Whatever, she wants to be dumb, that's her time wasted, not mine.

I guess it wasn't worth fighting the referral but that seems so unnecessary.

 

[smq123]

I guess it wasn't worth fighting the referral but that seems so unnecessary.

I would have fought harder but she literally looked at me with disgust for even suggesting that I would look "down there." Like, gasped, grasped the front of her cardigan closed, and drew back in her chair in disgust type of reaction.

 

[ThoracicGuy]

And @Winged Scapula I try not to ignore good advice so pretty pretty please with a cherry on top? I promise to behave. Mostly.

Ok, I'll see what I can do but you have to behave yourself!

 

[dpmd]

I would have fought harder but she literally looked at me with disgust for even suggesting that I would look "down there." Like, gasped, grasped the front of her cardigan closed, and drew back in her chair in disgust type of reaction.

Strange reaction. People are weird.

 

[Winged Scapula]

I would have fought harder but she literally looked at me with disgust for even suggesting that I would look "down there." Like, gasped, grasped the front of her cardigan closed, and drew back in her chair in disgust type of reaction.

Clutching her pearls no doubt (had she been wearing any).

That is weird; its not like she hasn't had someone looking at her vagina before. Like @dpmd says, people are weird.

Oh and I had that same mechanical valve experience; I was seeing the patient in a room while the med stud was in another. Brought her in to hear it. She was confused when I told her to be very very quiet and tell me what she heard.

 

[deleted547339]

Strange reaction. People are weird.

Meh. The ER is filled with these people and crap doctors that build false expectations. People are strange, but this seems unsurprising. Just this week, I saw:

Sent by PCP for SBP of 180 told they would be admitted. Nope - Asymptomatic, sent home.
Sent by urgent care for dizziness told they needed an MRI - not necessary.
Sent by trauma told that ortho would come down to tap a knee to rule out septic arthritis - ortho would laugh at me if I asked them to come down and tap a knee.
Sent by some doc (don’t remember who) because she “might have a concussion”.

Doctors don’t even understand what other doctors do. And patients want testing, meds and drama.