- Joined
- Jan 31, 2006
- Messages
- 626
- Reaction score
- 76
It has been suggested to me that I'm rather conservative in my approach to patients, with headaches as an example.
My approach is to suss out whether the patient has a history of headaches, whether this headache is similar to those (and if it's different, how), if the headache was sudden in onset, or if it's the worst of his life. (I also take into account comorbidities, such as HIV, etc). If the headache is WOL, or different from other headaches, or thunder-clap (or associated with fever/nuchal rigidity/etc), I tend to CT and LP.
The problem is, I seem to have a disproportionate number of patients who tell me, "Oh, yes, doctor. This is the WORST headache of my life." Or, "This is headache is *completely* different than my other headaches." Because I hear this so often, on occasion I even do tell my patients my concerns - such as, "I'm asking these questions because it's important for me to discern if this is a life-threatening cause of headache, such as something that would necessitate a spinal tap," or something along those lines. That way, I figure the over-exaggerators are less prone to do so.
Still, I keep hearing those buzz words from my patients and, in effect, feel obligated to do the CT/LP workup seemingly quite often. Thus the feedback from my staff that I seem to "CT everyone with headache." I'd like to think this is not the case. Does anyone else have a better approach to headache?
My approach is to suss out whether the patient has a history of headaches, whether this headache is similar to those (and if it's different, how), if the headache was sudden in onset, or if it's the worst of his life. (I also take into account comorbidities, such as HIV, etc). If the headache is WOL, or different from other headaches, or thunder-clap (or associated with fever/nuchal rigidity/etc), I tend to CT and LP.
The problem is, I seem to have a disproportionate number of patients who tell me, "Oh, yes, doctor. This is the WORST headache of my life." Or, "This is headache is *completely* different than my other headaches." Because I hear this so often, on occasion I even do tell my patients my concerns - such as, "I'm asking these questions because it's important for me to discern if this is a life-threatening cause of headache, such as something that would necessitate a spinal tap," or something along those lines. That way, I figure the over-exaggerators are less prone to do so.
Still, I keep hearing those buzz words from my patients and, in effect, feel obligated to do the CT/LP workup seemingly quite often. Thus the feedback from my staff that I seem to "CT everyone with headache." I'd like to think this is not the case. Does anyone else have a better approach to headache?
Last edited: