Crazy ?s

[docB]

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The "Art of Pimping" thread reminded me of this. When I was an MS III I started presenting a patient I had admitted the night before. "This is a 56 year old male with widely metestatic colon cancer who is here for neutropenic fever." I told the attending. She cut me off right there and asked "Oh, did you assess his risk factors for colon cancer?" I thought she was joking and just gave her the courtesy chuckle and started to move on when she stopped me again. "This is important." she said "Did you ask him about family history of colon cancer, high fiber diet, smoking and other risks?" "No." I said. "Well, you'll have to go back and complete your history later." I couldn't believe it.
Anyway, that is the craziest question I ever heard on rounds. Anyone else?

 

[The Pill Counter]

If I was lying in a hospital bed dying of metastatic colon cancer and some med student was quizzing me about what risk factors I have for the disease that is killing me, I'd tell him/her to get ****ed.

 

[eddieberetta]

that story is a perfect example of why I did not go into internal medicine.

 

[soon2bdoc2003]

Originally posted by eddieberetta
that story is a perfect example of why I did not go into internal medicine.

Amen to that

 

[GeneralTso]

Originally posted by eddieberetta
that story is a perfect example of why I did not go into internal medicine.

So true.

 

[Castro Viejo]

Originally posted by eddieberetta
that story is a perfect example of why I did not go into internal medicine.

You gotta love those internists.

God bless internal medicine and may He have mercy on the soles of those who LIVE FOR ROUNDING.

 

[Stormreaver]

That indeed is a truly crazy question. The only time I've run into attendings like that is when the lab rats come out to do their ward month after 2 years of torturing rodents.

And we round to live, not the other way round 🙂

 

[DR]

Ahh, a fellow internist. I agree that the question was a bit silly, however I think that if we got a thread started on stupid questions asked by other specialists, we'd get some gems as well. I think there are ridiculous pimp questions in all realms. I was asked who the father of antiseptic practice was...now THAT is friggin' ridiculous.

 

[GeneralTso]

Originally posted by DR
Ahh, a fellow internist. I agree that the question was a bit silly, however I think that if we got a thread started on stupid questions asked by other specialists, we'd get some gems as well. I think there are ridiculous pimp questions in all realms. I was asked who the father of antiseptic practice was...now THAT is friggin' ridiculous.

Lister...duh

 

[neurogeek]

Semmelweis was the "Father of antiseptic practice" - in my book.

 

[sweetfynesse]

After two weeks of being totally ignored, I was finally asked a question by a trauma surgeon whom said, "why does is not lightening when it snows?"

I disgustingly said, "I don?t know", and went about my business...

 

[docB]

The only time I've run into attendings like that is when the lab rats come out to do their ward month after 2 years of torturing rodents.

Yeah, there are those types but in this case she was a really great attending except for this one weird question. I guess we all have those days where the synapses don't fire quite right.

And BTW I didn't intend for this thread to bash IM. As others have mentioned every specialty asks dumb questions from time to time.

 

[smackdaddy]

out of curiosity why were those dumb questions? they seem very reasonable to me.
indelicate perhaps, but they still need to be asked. and especially at the ms3 level, the importance of taking a complete history is to be emphasized frequently over the specifics of the information obtained.
while it may be too late for this particular patient, the information would still be valuable to society, to you, and more importantly, potentially to the immediate family members.

a stupid question is why do birds have wings? why does my dog lick what's left of his balls?

 

[OldManDave]

Originally posted by docB
The "Art of Pimping" thread reminded me of this. When I was an MS III I started presenting a patient I had admitted the night before. "This is a 56 year old male with widely metestatic colon cancer who is here for neutropenic fever." I told the attending. She cut me off right there and asked "Oh, did you assess his risk factors for colon cancer?" I thought she was joking and just gave her the courtesy chuckle and started to move on when she stopped me again. "This is important." she said "Did you ask him about family history of colon cancer, high fiber diet, smoking and other risks?" "No." I said. "Well, you'll have to go back and complete your history later." I couldn't believe it.
Anyway, that is the craziest question I ever heard on rounds. Anyone else?

That is pretty wild...but I think I have you beat. One of my classmates was on call for Infernal Med during our MS-III year. He was called to the ER to do an H&P on a GI bleed that was being admitted. When he arrived, the patient was having very frequent, massive bowel movements of mixed old & new blood. Fortunately, he mentioned this to the surgical resident on call and the guy went to the ICU & then to the OR.

However, when he was presenting the patient in rounds the next morning, he was asked whether or not he had done a rectal & guiaic for occult blood. He replied, "No, it was obviously positive - he was passing pure blood".

Of course, being an internist (which I believe is Latin for 'people who spend their days looking for reasons to stick their fingers in other people's asses'), the attending countered that she was serious & cited an entire litany of things on a differential that could have excluded by a rectal & guiaic -- never mind the fact the poor guy was grossly hemorrhaging and needed more assistance than can be rendered by an MS-III with a glove, guiaic card & KY jelly.

 

[Stormreaver]

Originally posted by docB
As others have mentioned every specialty asks dumb questions from time to time.

Like a surgeon asking me whether I was checking ammonia levels everyday on a patient with a crystal-clear mental status...

 

[docB]

out of curiosity why were those dumb questions? they seem very reasonable to me. indelicate perhaps, but they still need to be asked. and especially at the ms3 level, the importance of taking a complete history is to be emphasized frequently over the specifics of the information obtained. while it may be too late for this particular patient, the information would still be valuable to society, to you, and more importantly, potentially to the immediate family members.

They would be dumb questions in this case because they could not possibly yeild any useful information to me or society or the patient's family. Let's say that this patient had a high fiber diet, no family history and was a non smoker. What am I going to say to him? "Gosh, sir. It was very unlikely that you got this horrible disease that's killing you." As for me, I already knew that he was at high risk for cancer based on the fact that he had it. In fact his risk of having cancer was about 100%. As for his family, they are now at higher risk for cancer regardless of what risk factors the patient had. His dietary fiber intake has no bearing on the fact that they all now have a positive family history.
Part of learning to be a good doctor is knowing what not to do and that pertains to history taking as well. Do you think we really ask the little 80 year old ladies with chest pain about their sexual history?

 

[Mindy]

Okay this isn't a question... its really just a cute story...

I had the most adorable 80-something year old patient, whose name was Henry Sweet *. I just couldn't believe my eyes when I typed his name into the computer system to obtain some lab results and only 2 names showed up...

 

[Mindy]

Henry Sweet *

&

Henry Sweeter *



...I almost experienced stress incontinence that day!



Mindy

*I changed the first names to protect confidentiality...

 

[beezar]

Originally posted by OldManDave
That is pretty wild...but I think I have you beat. One of my classmates was on call for Infernal Med during our MS-III year. He was called to the ER to do an H&P on a GI bleed that was being admitted. When he arrived, the patient was having very frequent, massive bowel movements of mixed old & new blood. Fortunately, he mentioned this to the surgical resident on call and the guy went to the ICU & then to the OR.

However, when he was presenting the patient in rounds the next morning, he was asked whether or not he had done a rectal & guiaic for occult blood. He replied, "No, it was obviously positive - he was passing pure blood".

Of course, being an internist (which I believe is Latin for 'people who spend their days looking for reasons to stick their fingers in other people's asses'), the attending countered that she was serious & cited an entire litany of things on a differential that could have excluded by a rectal & guiaic -- never mind the fact the poor guy was grossly hemorrhaging and needed more assistance than can be rendered by an MS-III with a glove, guiaic card & KY jelly.

That is freaking ridiculous. Has all logic gone out the window?! Thank god i only have to do 3 months of medicine during my transitional year...

 

[mhdousa]

Originally posted by docB
The "Art of Pimping" thread reminded me of this. When I was an MS III I started presenting a patient I had admitted the night before. "This is a 56 year old male with widely metestatic colon cancer who is here for neutropenic fever." I told the attending. She cut me off right there and asked "Oh, did you assess his risk factors for colon cancer?" I thought she was joking and just gave her the courtesy chuckle and started to move on when she stopped me again. "This is important." she said "Did you ask him about family history of colon cancer, high fiber diet, smoking and other risks?" "No." I said. "Well, you'll have to go back and complete your history later." I couldn't believe it.
Anyway, that is the craziest question I ever heard on rounds. Anyone else?

i agree, it's a ridiculous question to ask in the throes of neutropenic fever, but just for argument's sake, what if the attending was thinking about FAP or HNPC? a good family history could rule these in or out. if you've got a huge FHx of colon
CA, it might be a good idea to warn future family members.

 

[docB]

i agree, it's a ridiculous question to ask in the throes of neutropenic fever, but just for argument's sake, what if the attending was thinking about FAP or HNPC? a good family history could rule these in or out. if you've got a huge FHx of colon

Maybe I wasn't clear in my initial description. This patient had metestatic, adenocarcinoma of the colon, diagnosed by biopsy, treated by oncologists. There was no differential. There was no debate. He didn't need a work up. He just needed management of his neutrapenic fever. There was no valid reason to try to ascertain his risk for the disease he has.

 

[mhdousa]

docb,

you were completely clear in your description. i wasn't clear in what i was saying. nothing discovered in the family history (or in any part of the history, for that matter) will change your management of THIS patient, but if 6 generations of family members developed colon CA in their 50s, then you've got a good case for one of the autosomal dominant polypoid or non-polypoid conditions. if that's
the case, then, as far as i remember, any child of this patient has a 50% chance of developing colon CA at an early age. then the children would need to undergo surveillance for polyps. i thought that maybe that's what your attending was getting at by asking if you had taken a family history.

someone please correct me if i'm wrong.

-M

 

[smackdaddy]

Originally posted by docB
They would be dumb questions in this case because they could not possibly yeild any useful information to me or society or the patient's family. Let's say that this patient had a high fiber diet, no family history and was a non smoker. What am I going to say to him? "Gosh, sir. It was very unlikely that you got this horrible disease that's killing you." As for me, I already knew that he was at high risk for cancer based on the fact that he had it. In fact his risk of having cancer was about 100%. As for his family, they are now at higher risk for cancer regardless of what risk factors the patient had. His dietary fiber intake has no bearing on the fact that they all now have a positive family history.
Part of learning to be a good doctor is knowing what not to do and that pertains to history taking as well. Do you think we really ask the little 80 year old ladies with chest pain about their sexual history?

i wonder why they are making you do residency? it sounds like you know everything already.
🙄
if you knew the answers already, you could have just told the attending that. sheesh.

 

[robinhudster]

smackdaddy, why the sarcastic tone? I think anyone who can't see the stupidity of the attending's question needs a reality check. doc b is absolutely right. And to those who claim that it's important to take a hx. to warn family members, do you really think fam members don't already now know that hey are at inc. risk?? Do you not think that they are now all so concerned that they are lining up for colonoscopies? come on guys, there's a difference between teaching and being a jerk. If the attending wanted to teach she could have asked the student: so, what are the risk factors for colon CA!!!! It's that simple.

 

[smackdaddy]

i will repeat why are the questions stupid? docb says society has nothing to learn by asking about risk factors from patients who are going to die. obviously i disagree, but at least, he/she answered the question. again, even above the obvious and unrelated point of an m3 needing to learn how to take important components of the history, (which may have been the whole point- a gentle way of telling you that you haven't been doing a good job of getting the history expected at the m3 level), there are a lot of reasons to ask the questions. agreed, it would probably not benefit this patient. do you really think there is no benefit to society to learn these things? it didn't sound (to me) from the description of the questions that the attending was being a jerk. just that they expected you to know these things. maybe there was a study that the patient could have qualified for. who knows?

as for the sarcasm, gosh, i guess there wasn't sarcasm dripping from the post i quoted either? 😉
i'm sure docb is a big boy or girl and can take it.


many family members do not know they are at increased risk.
i can't believe you are so naive to think that most family members are lining up for colonoscopy just because one of their family died from colon cancer. if you really believe that, you are the one out of touch.

 

[Mindy]

Since everyone ignored my "cute little story", I am in the mood for debate 😉
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"Did you ask him about family history of colon cancer, high fiber diet, smoking and other risks?"
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In an epidemiologic sense, answers to these questions would provide fairly weak retrospective evidence in regards to the cause and effect of colon cancer. Consider this a study with a population of 1. What if the most outstanding pertinent positive on this fellow was that he was a stamp collector and licked stamps for 30+ years. Could one draw a conclusive causal association between the material ingested from the back of his stamps and colon cancer? Also, the risk factors for colon cancer stem from corollative epidemiologic evidence, meaning that although cause and effect is often wrongly inferred it is not established. Therefore even by knowing this pt had a risk factor, one cannot assume that caused his disease. The exception of course is the inheritable colon diseases with well-defined carcinogenic properties and as such family history may be a warranted question to ask this patient. A colonoscopy or gross exam would definitively rule in polyposis coli, however.

The definitional purposes of assessing risk factors are twofold: 1) to identify pt's at risk for certain diseases, and 2) to modify these factors to help prevent disease. Clearly neither of these are helpful to this gentleman. So generally speaking, assessing the patient post hoc for risk factors will probably provide little useful information. The only reason to ask this pt about potential risk factors would be to develop hypotheses for further testing. In essence, does stamp-licking cause colon cancer?

DocB proposed that asking these questions were worthless, and SmackDaddy claimed the opposite. Mhdousa proposed a intergenerational reason for investigating family history. Interesting how these lines of reasoning affect the future of medical science. DocB would miss an important finding that stamp-licking is the cause of colon cancer. SmackDaddy would publish a small pilot showing an increase risk of colon ca in postal workers in the NEJM and we would all be taping our stamps to letters after 60 minutes got ahold of the story. The findings would be reversed years later after the NIH granted a billion dollars for a full-scale project. Mhdousa would be draining blood from this pt's relatives to find a common DNA link for their multigenerational colon cancers. Me, I would sit back an over-intellectualize it all.

Mindy

 

[MBK2003]

But sometimes we have to just admit that the horse is out of the barn and leave things be for the sake of the patient's comfort.

This reminds me of an incident I observed with a Neuro resident interviewing the family of a patient transferred to our tertiary care center overnight. Patient was a mid40's male who had a CVA 2 days prior and was transferred to our hospital after he lost all brainstem reflexes, under the premise that "the doctors at the University Hospital are his best chance for a full recovery." The resident (quite a gung ho fellow, mind you) spent fifteen minutes interrogating the family about the patient's risk factors for a stroke (including "did he ever have his homocysteine levels checked?"). And the kicker was that he ended the interview with, "Well we did a full neuro exam on your husband this morning and it appears as if he is brain dead, so we will be taking him off the ventilator later this morning. Do you have any additional questions?"

My personal take home message from that unfortunate exchange was that sometimes offering a patient and family care and compassion is of much greater benefit than an in-depth analysis of why the disease occurred.

MBK2003

P.S. My favorite crazy question, from an ER attending, "What color were his socks?" - after presentation of a patient well known to the ER for DT admissions Q2months. The answer was "white with blue stripes on the left and grey with red stripes on the left." Because "I know that they were two different colors" was not specific enough.

 

[almostMD]

In all seriousness, someone above asked why it would be important to ask an old lady with chest pain what her sexual history is. I have only this to add:

I had an 82 year old lady with chest pain who turned out to have an ascending aortic aneurysm due to tertiary syphilis. She gave me a history of an untreated lesion on her vulva 30 years prior.

Just goes to show ya how important every part of a patient's history is!

 

[trex92499]

I've actually found that asking elderly people about their sexual history or any sexual problems is helpful, because many times they are having sexual dysfunctions that they want to correct so that they can continue having sex...I've had numerous decreased libido B-blocker patients and several vaginal dryness ones...and they've all said they were glad I asked because their PCP never did and they were embarassed to bring it up...

And my favorite crazy question was, in a 20 year old with a 2 day history of pneumonia, with confirmatory sputum sample, no PMH of pulmonary probs, no smoking, incredibly heathly and athletic except for the pneumo....Did you check his nails for clubbing? I said no, due to the brevity of the illness, I didn't think it was necessary since clubbing would not manifest overnight...to which he replied...well it could be inherited w/out pathology. I kept my mouth shut and thought...then what would that tell us about the patient?

 

[Tazmaniac]

Slightly tangential but a 'crazy' question I had asked:

I was an MS I, doing my first peds interview with 11-year-old daughter s/p appendectomy who couldn't care about anything, and a mom who only spoke spanish.

My spanish was terrible back then, but I had recently learned the word "embarazada," which means pregnant.

So in the PMHx section of the interview, I asked the mother, "How was the pregnancy?"

...except I didn't know how to use past tense. I had said to her: "como es la embarazadad?" which literally means "how is the pregnancy" instead of "how was the pregnancy."

Well!

Mom was not a happy camper and she stared at me with such vampiric, loathesome eyes that I pretty much ended the interview right then and there. She kept repeating: "FUE?" "FUE?" (past tense: I should've asked "Como fue la embarazadad?")

So now my spanish is improved (though still not without problems), and my spanish-speaking patients are delighted if not confused when I fluently ask them whether they had passed smelly gas s/p bowel surgery.

-Todd MSIII USC

 

[docB]

Well bravo to all you zebra hunters out there. Having the benefit of both medschool and residency experience I maintain that I would still not return to the dying guy's room and interrogate him about the fiber content of his diet nor do I intend to query my cardiac patients about their sexual histories especially if it ended during the Nixon administration.
As for Smackdaddy's reply, sure I can take it, I just didn't think it was called for.

 

[trex92499]

For me, asking EVERYONE sexual history began because I was so uncomfortable asking anyone about sex or saying penis or vagina...immature, I know, which is why I just started asking everyone, so that I'd get over my shyness and embarassment...I continued because so many patients started responding so enthusiastically, because even old people want to have sex...so don't assume they're not having it or if they're not having it, that they don't want to have it, because they most likely do.

But I completely agree about asking questions that are completely implausible or about factors for which the patient is WAY beyond help. What was the attending going to do...tell the guy, well you've got met. colon ca, but if you'd just eaten more fiber, you wouldn't be here. I've seen people do similar things to this, like saying, oh mr brown, you've had a mi, I told you you should have had those lipid panels done...if a person is extremely sick or dying, do you really want to make them think that it was all their fault? (even if it was) Imo, that is what some of the questions we ask cause.