does this happen often?

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chugalong

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I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

Happens all the time. Usually the residents/attendings know you weren't lying.
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

Pretty common. Seems like residents and attendings know patients say all kinds of crazy **** for no reason. Wouldn't let it bother you.
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

This happens a lot.
 
greatnt249 said:
Happens all the time. Usually the residents/attendings know you weren't lying.
Click to expand...

Yeah, I was paranoid about it at first too. A few weeks into third year I realized no two people ever take the same history. I've had patients tell me they vomited and tell my resident they did not, tell me they had fever for 2 weeks and tell my resident they were never febrile, tell me they have no pain anywhere and tell the resident they have a killer headache.

This is gonna happen a lot more, so just understand where everyone is coming from when they give you information.
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

The dreaded "Attending Sign".....Makes every student look like a jack-ass at one point or another 🙂
Best you can do is document/present that you asked about a specific thing so they know you actually know what you're doing
 
chugalong said:
and if it's common?
Click to expand...
Very.

My only advice is to make sure you're honest. If you didn't ask something, just say so. The vast majority of the time, the attending knows that the patient's story will change sometimes. As long as you don't have a reputation for being a sneaky weasel, they'll give you the benefit of the doubt.
 
you can count on one thing......people are unreliable and inconsistent in general.

Also, if the patient has an established relationship with the attending, then you will get a limited history and they will get tons more info out of them.

What can you do? Just do your best to not miss anything obvious or that should normally be asked.
 
Happens to me all the time. Especially in the ED and especially with pain. Someone comes into the room who the pt thinks can get them pain meds and suddenly pain is 10/10 when 5 mins ago it was 5/10.

I also had a patient realize I wasnt one of the more seasoned members of the team and they tried to get some pain meds outta me (fail), but the attending came in and they realized they couldnt run that scam on him and the pt backed down about his "pain" pretty quick
 
Gotta love the "attending sign" - super common - as previously stated.

When it happens, I usually tell the attending something along the lines of "I swear that I really did ask that question and they answered XXXX" - I've found that directly addressing it usually leads to the attending laughing then reminiscing on when it happened to him/her in medical school. I know that might sound stupid, but it's better than leaving it alone and wondering whether or not the attending thinks you just lied about asking the question.
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

It occurs to everyone at some point. But be sure that when it does occur you pay close attention to the way the attending/resident words their question. Often changing a few words will elicit a different answer.
 
Wow, even as a resident this kind of thing haunts me. Less so with respect to the pain or ambulatory ability etc. It seems when the "doctor" comes in they want to get positive feedback so they often minimize their pain and overstate their ability to perform and then when the midlevels, nursing, or physical therapy come in they are in horrific pain or can not move. What I get nervous about is if they have a clear exam change from when I last saw them.. Did I miss something? Did I not reassess soon enough? What could I have done differently. Regardless, exams change, patients lie, and more often than not its not a big deal. Just do due diligence and whats best for the patient and you'll always have a leg to stand on.
 
TarHeelEMT said:
Happens all the time.
Click to expand...

Had a patient who flat out denied chest pain to the triage nurse who asked her directly. Just a "resolved episode" of dyspnea. So she gets pushed back in line about an hour before getting a room or an EKG. So when she finally gets in a room, I get achart with an ugly looking EKG attached: Woman gives me a straight up story of ongoing exertional dyspnea and substernal CP. Sorry ma'am, we just delayed your transfer for an emergent cath by an hour. If you had told us at triage the first time we asked if you had chest pain, you'd have had your coronaries opened by now.

Historical drift happens at all stages of the game to everyone from med student to nurse to resident even to attending if we checked each other's patients I'm sure.
 
Last edited:
red10 said:
Happens to me all the time. Especially in the ED and especially with pain. Someone comes into the room who the pt thinks can get them pain meds and suddenly pain is 10/10 when 5 mins ago it was 5/10.

I also had a patient realize I wasnt one of the more seasoned members of the team and they tried to get some pain meds outta me (fail), but the attending came in and they realized they couldnt run that scam on him and the pt backed down about his "pain" pretty quick
Click to expand...

This is the second, more nefarious, reason for changing stories. On an EM rotation, I had a drug seeker's story change in front of me (and the senior resident was in the room too) from "I'm constipated" to "No, of course I'm not constipated. In fact--I'm having diarrhea. Yeah, bad diarrhea, doc," when he realized we were going to use constipation as one of the reasons for not giving narcs.
 
It happens to the residents as well! One of the interns on my internal med team had 3 delirious patients on his list that all decided to go back to a normal mental status by the time we rounded 1-2 hours after he saw them...

Most attendings are aware that patient's stories do change so I usually don't say anything after they see the patient unless it was something pretty important to the patient's history and makes me look like an idiot if I missed it. For example, a guy once came into the ED for a headache telling me it started when he woke up a few days before. He had gone to another ED so I went to get the records of his LP and CT scan as the resident went to see the patient. His headache sounded like a migraine, his exam and vitals were completely normal, and he was pretty young so their work up seemed a bit excessive. Then the resident came back with the real story of how the headache had started while he was having sex with his wife which sounds like the history of a head bleed... I guess he was too embarassed to tell me (a female) and felt more comfortable telling the male resident.
 
chugalong said:
I'm a fresh M3 and was wondering what everyone does in this situation and if it's common?

basically you ask a patient on thing...get a full picture and then you present..ex: patient says it's not too bad he can deal with the pain and it's getting better...

then attending/resident walks in after you've presented..and pt says..pain is pretty severe, and then you look like an idiot..even worse looks like you lied and made up the history...
Click to expand...

This happens to residents, too. Patients will also intentionally leave things out until "the doctor" is in the room. This is particularly funny when your resident is doing a fellowship or second residency.
 
Rendar5 said:
Had a patient who flat out denied chest pain to the triage nurse who asked her directly. Just a "resolved episode" of dyspnea. So she gets pushed back in line about an hour before getting a room or an EKG. So when she finally gets in a room, I get achart with an ugly looking EKG attached: Woman gives me a straight up story of ongoing exertional dyspnea and substernal CP. Sorry ma'am, we just delayed your transfer for an emergent cath by an hour. If you had told us at triage the first time we asked if you had chest pain, you'd have had your coronaries opened by now.

Historical drift happens at all stages of the game to everyone from med student to nurse to resident even to attending if we checked each other's patients I'm sure.
Click to expand...



EMS gets it pretty badly, too. Plenty of frequent fliers look at us as nothing more than a taxi service and will give us a totally different story. I've looked like a fool in front of the ED charge nurse many times.
 
dally1025 said:
It happens to the residents as well! One of the interns on my internal med team had 3 delirious patients on his list that all decided to go back to a normal mental status by the time we rounded 1-2 hours after he saw them...
Click to expand...

That's not the fault of the patient for 'lying'. That's one of the defining characteristics of delirium...
 
DrSnips said:
Yeah, I was paranoid about it at first too. A few weeks into third year I realized no two people ever take the same history. I've had patients tell me they vomited and tell my resident they did not, tell me they had fever for 2 weeks and tell my resident they were never febrile, tell me they have no pain anywhere and tell the resident they have a killer headache.

This is gonna happen a lot more, so just understand where everyone is coming from when they give you information.
Click to expand...

I had a patient completely contradict himself within the same interview today - about a major complaint too. It happens.
 
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