Comments on: Tweeners http://trismus1.wordpress.com/2008/02/16/tweeners/ My experiences as an ER doc Tue, 08 Dec 2009 19:37:38 +0000 http://wordpress.com/ hourly 1 By: s http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6143 s Wed, 20 Feb 2008 11:59:53 +0000 http://trismus1.wordpress.com/?p=177#comment-6143 ED where i used to work, that sort of patient was bound to be sent home. a whole range of seemingly unrelated symptoms (especially the 'numbness' type) and no real hard signs with a negative CT... i mean, some of those patients wouldnt have scored the CT even. it'd be a real challenge finding a team that'd admit her too. ED where i used to work, that sort of patient was bound to be sent home. a whole range of seemingly unrelated symptoms (especially the ‘numbness’ type) and no real hard signs with a negative CT… i mean, some of those patients wouldnt have scored the CT even. it’d be a real challenge finding a team that’d admit her too.

]]> By: Ryan http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6142 Ryan Tue, 19 Feb 2008 21:33:55 +0000 http://trismus1.wordpress.com/?p=177#comment-6142 As you probably know, I'm a send-homer, and she would definitely be going home if it were me. That doesn't mean that there won't eventually be a wolf, but if you don't really suspect that she's had a stroke (not a TIA if her symptoms haven't gone away), then you aren't doing her a favor by putting her in the hospital. As you probably know, I’m a send-homer, and she would definitely be going home if it were me. That doesn’t mean that there won’t eventually be a wolf, but if you don’t really suspect that she’s had a stroke (not a TIA if her symptoms haven’t gone away), then you aren’t doing her a favor by putting her in the hospital.

]]> By: Dr K http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6139 Dr K Tue, 19 Feb 2008 14:01:46 +0000 http://trismus1.wordpress.com/?p=177#comment-6139 Remember, you're not treating the labs- you're treating the lawyer! :-) Remember, you’re not treating the labs- you’re treating the lawyer! :-)

]]> By: truce http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6136 truce Tue, 19 Feb 2008 03:58:15 +0000 http://trismus1.wordpress.com/?p=177#comment-6136 You're a doctor, not a magician - you can't be expected to spot and prevent every possible ailment. :) Although I expect that argument doesn't work very well with Lawyers, huh? You’re a doctor, not a magician – you can’t be expected to spot and prevent every possible ailment. :)

Although I expect that argument doesn’t work very well with Lawyers, huh?

]]> By: Ten out of Ten http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6135 Ten out of Ten Mon, 18 Feb 2008 22:14:33 +0000 http://trismus1.wordpress.com/?p=177#comment-6135 In the end, I decided it all added up to a whole lot of nothing and sent her home on a baby aspirin a day and "close" followup. I don't know how she did, this happened a few months ago and she hasn't been back since. I'd call to see how she's doing but everyone with her was spanish speaking only. I don't like these patients. Even though I'm virtually certain it's nothing it just takes one of them to come back with a stroke for me to feel terrible and be screwed. In fact, it just takes one to happen to have a stroke, unrelated to the symptoms she was having during the visit, for me to be screwed. I just do my best to practice sensible medicine, and keep my fingers crossed that I'm not unlucky enough to have a bad outcome. Sorry to anyone expecting a zebra punchline! In the end, I decided it all added up to a whole lot of nothing and sent her home on a baby aspirin a day and “close” followup.

I don’t know how she did, this happened a few months ago and she hasn’t been back since. I’d call to see how she’s doing but everyone with her was spanish speaking only.

I don’t like these patients. Even though I’m virtually certain it’s nothing it just takes one of them to come back with a stroke for me to feel terrible and be screwed. In fact, it just takes one to happen to have a stroke, unrelated to the symptoms she was having during the visit, for me to be screwed.

I just do my best to practice sensible medicine, and keep my fingers crossed that I’m not unlucky enough to have a bad outcome.

Sorry to anyone expecting a zebra punchline!

]]> By: tori http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6132 tori Mon, 18 Feb 2008 17:18:47 +0000 http://trismus1.wordpress.com/?p=177#comment-6132 If you admit someone when you think they might be a little overdramatic, aren't you reinforcing to them that they should come in with every little thing? Isn't it sort of like giving someone antibiotics because you can't get them to understand that they are not useful in a virus? I'm not a doctor, so I have no idea of course and I know if you missed something it would be bad for you and for them. I guess that is why it is such a fine line for you to walk in figuring this out. This is why I bring cookies for my doctors all the time...my little way of showing them that I know they go through a lot and I appreciate what they do for me. If you admit someone when you think they might be a little overdramatic, aren’t you reinforcing to them that they should come in with every little thing? Isn’t it sort of like giving someone antibiotics because you can’t get them to understand that they are not useful in a virus? I’m not a doctor, so I have no idea of course and I know if you missed something it would be bad for you and for them. I guess that is why it is such a fine line for you to walk in figuring this out. This is why I bring cookies for my doctors all the time…my little way of showing them that I know they go through a lot and I appreciate what they do for me.

]]> By: truce http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6131 truce Mon, 18 Feb 2008 07:28:43 +0000 http://trismus1.wordpress.com/?p=177#comment-6131 This isn't remotely helpful, but hey, you don't know me so what do I care, right? I am SO GLAD I'm an artist, not a doctor. When I make stuff up, people are pleased. :) This isn’t remotely helpful, but hey, you don’t know me so what do I care, right? I am SO GLAD I’m an artist, not a doctor. When I make stuff up, people are pleased. :)

]]> By: amy, rn http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6130 amy, rn Mon, 18 Feb 2008 06:03:34 +0000 http://trismus1.wordpress.com/?p=177#comment-6130 I'm with those whose call is that this woman is somaticizing, and needs to be sent home, where the root problem can be more effectively addressed. In your area, is there any way to arrange for follow-up by a public health nurse who will go to the home? A monthly visit, if at all possible, might just keep the patient from being an ER regular. I get where Nurse K is coming from, but as a psych nurse, I have to disagree that giving a benzo - under the guise of medication made specifically for her problem - is the thing to do. If she'd had a psych consult while in the ER with a conclusive diagnosis of major anxiety disorder, sure. Otherwise, we've seen too many problems crop up from giving antianxiety meds that supposedly treat a specific physical disorder. I’m with those whose call is that this woman is somaticizing, and needs to be sent home, where the root problem can be more effectively addressed. In your area, is there any way to arrange for follow-up by a public health nurse who will go to the home? A monthly visit, if at all possible, might just keep the patient from being an ER regular.

I get where Nurse K is coming from, but as a psych nurse, I have to disagree that giving a benzo – under the guise of medication made specifically for her problem – is the thing to do. If she’d had a psych consult while in the ER with a conclusive diagnosis of major anxiety disorder, sure. Otherwise, we’ve seen too many problems crop up from giving antianxiety meds that supposedly treat a specific physical disorder.

]]> By: jerry http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6129 jerry Mon, 18 Feb 2008 04:20:08 +0000 http://trismus1.wordpress.com/?p=177#comment-6129 The diagnosis is very clear. It is a variant of "status hispanicus" or AKA "hispanic panic" characterized by variations of numbness, heaviness, and dizziness. This is a condition caused by percieved neglect from her family and boredom of staying home all day. By going to the hospital she gets some attention and her "sickness" is validated by all the tests that are performed to check her out. She should go home. If you have more than 5 chief complaints no emergency medical condition exists. The diagnosis is very clear. It is a variant of “status hispanicus” or AKA “hispanic panic” characterized by variations of numbness, heaviness, and dizziness.

This is a condition caused by percieved neglect from her family and boredom of staying home all day. By going to the hospital she gets some attention and her “sickness” is validated by all the tests that are performed to check her out.

She should go home. If you have more than 5 chief complaints no emergency medical condition exists.

]]> By: pubaid http://trismus1.wordpress.com/2008/02/16/tweeners/#comment-6128 pubaid Sun, 17 Feb 2008 22:12:14 +0000 http://trismus1.wordpress.com/?p=177#comment-6128 did she end up with bell's palsy or really no way to know what happened after she was sent away... did she end up with bell’s palsy or really no way to know what happened after she was sent away…

]]>