Sorta saved a dude's life?

[DD214_DOC]

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So here's an interesting story and a good take-home point to always stay abreast with one's medical knowledge. I guess I sorta saved this dude's skin in a way, although I did not directly intervene.

Was interviewing a female patient in the ED for SI and s/p SA. Her husband, who is completely borderline/histrionic, kept interrupting us with the story of how he had to go down to the gift shop in the hospital to get some tylenol because the ER wouldn't give him any; he interrupted my interview at least 5 times to tell me this.

At first, I was a bit annoyed. However, my gestalt told me to dig a little deeper with the husband of the patient. I asked him a few questions about his headache and he noted some disturbance in vision during my super-quick ROS. I thought something serious might be going on, so I rushed him back to the Triage area and had the ER check him in and work him up.

Turns out the dude had an acute subdural hematoma with midline shift and uncal herniation! He had an emergency craniotomy that night.

I ended up having him afterwards on the C/L service for a stupid consult ("Male with h/o MDD, outpatient meds held for surgery, please recc meds to restart pt on").

Makes me glad I didn't completely ignore him, otherwise he would have gone home to die.

 

[whopper]

I've had a few interesting cases but in the opposite manner. E.g. someone is in the psychiatric hospital, is having a serious medical problem and needs to be in a medical hospital (psychiatric hospitals often only have primary care level facilities), but the local medical hospital refuses to take the patient.

That's great that you did what you did. It's a sign that you are still sharp on your medical skills.

 

[JabsterL]

So here's an interesting story and a good take-home point to always stay abreast with one's medical knowledge. I guess I sorta saved this dude's skin in a way, although I did not directly intervene.

Was interviewing a female patient in the ED for SI and s/p SA. Her husband, who is completely borderline/histrionic, kept interrupting us with the story of how he had to go down to the gift shop in the hospital to get some tylenol because the ER wouldn't give him any; he interrupted my interview at least 5 times to tell me this.

At first, I was a bit annoyed. However, my gestalt told me to dig a little deeper with the husband of the patient. I asked him a few questions about his headache and he noted some disturbance in vision during my super-quick ROS. I thought something serious might be going on, so I rushed him back to the Triage area and had the ER check him in and work him up.

Turns out the dude had an acute subdural hematoma with midline shift and uncal herniation! He had an emergency craniotomy that night.

I ended up having him afterwards on the C/L service for a stupid consult ("Male with h/o MDD, outpatient meds held for surgery, please recc meds to restart pt on").

Makes me glad I didn't completely ignore him, otherwise he would have gone home to die.

Wow, that's crazy serendipitous how he kept interrupting to bring up his headache to you, and even more awesome how you helped save his life! Way to go HooahDoc, u've definitely made all of us in this forum very proud!

 

[Doc Samson]

Strong work.

 

[sunlioness]

Awesome! 👍

 

[OldPsychDoc]

And here you thought you would lose your doctoring skills if you went into psych...
😎

 

[peppy]

So there's the answer to your other thread: You do have a point. A practitioner with strong skills in both general medicine and psychiatry can make a huge difference in people's lives, even if not always in the expected way.

 

[digitlnoize]

Awesome. I had a kinda similar experience last month on my 3rd year FM rotation, although a much less acute case. Saw a guy who had been dx with anxiety and depression by a psychiatrist, kind of written off as a psych case by his FP. Other sx included fatigue, muscle aches, hx of SVT arrhythmia, and slightly elevated liver enzymes. Oh, and he looked a little tan for the Virginia winter. Thyroid stuff came back negative, so I suggested we check his iron studies for hemochromatosis. Sure enough, he's got it. Hopefully the tx will improve his psych sx somewhat. Regardless, he's still young (mid-30s) and I'm hoping we prevented a bunch of complications...

I feel like the opportunity to catch things like this is abundant in psych. I've seen so many doctors write off so many pt sx as being psych related without really digging deeper that psychiatrists have to get a fair amount of pt's who have other undiagnosed medical conditions. The classic example is thyroid dysregulation, but I'm sure there's a fair amount of CA, hemochromatosis, anemia, sleep apnea, etc impacting the mood of psych patients just waiting to be caught by an observant psychiatrist.

 

[nitemagi]

I feel like the opportunity to catch things like this is abundant in psych. I've seen so many doctors write off so many pt sx as being psych related without really digging deeper that psychiatrists have to get a fair amount of pt's who have other undiagnosed medical conditions. The classic example is thyroid dysregulation, but I'm sure there's a fair amount of CA, hemochromatosis, anemia, sleep apnea, etc impacting the mood of psych patients just waiting to be caught by an observant psychiatrist.

The amount of times I've seen SERIOUS medical problems blown off as "due to their primary psychiatric condition" is astounding. From a patient with lower extremity weakness (and documented spinal cord compression on MRI in the EMR), to a stuporous patient s/p overdose. Yes, the ED resident tried to explain to me that her stupor was due to her "primary psychiatric condition." I had to politely tell her there are no psychiatric conditions that cause that. Amazing.

 

[Manicsleep]

Congratulations. This won't be your last time.

I feel like the opportunity to catch things like this is abundant in psych. I've seen so many doctors write off so many pt sx as being psych related without really digging deeper that psychiatrists have to get a fair amount of pt's who have other undiagnosed medical conditions. The classic example is thyroid dysregulation, but I'm sure there's a fair amount of CA, hemochromatosis, anemia, sleep apnea, etc impacting the mood of psych patients just waiting to be caught by an observant psychiatrist.

👍

The amount of times I've seen SERIOUS medical problems blown off as "due to their primary psychiatric condition" is astounding. From a patient with lower extremity weakness (and documented spinal cord compression on MRI in the EMR), to a stuporous patient s/p overdose. Yes, the ED resident tried to explain to me that her stupor was due to her "primary psychiatric condition." I had to politely tell her there are no psychiatric conditions that cause that. Amazing.

👍

Sometimes they are just blown off, the dump has become an art, especially in hospitals. However, there are times, these aren't being blown off, people just don't have the expertise in psychiatry. I catch these things in my outpatient practice as well. I have caught patients being put on medications that just don't interact well. Conversely, I have been the cause of side effects as well and have had primary care physicians who catch the problem although they sometimes don't know the cure. I can then change meds, alter dosing etc.

This is why we go to medical school and do rotations in a variety of specialties and why we have a broad base of training prior to that. It is also why it is astounding and horrifying that the ability to do this very thing is being given to those with a pittance of training.