Not doing that again

Code 3 for the unknown.

A woman in her early 30s is in her office, where her co-workers called because she just “isn’t herself.” It is clearly a reliable and professional environment, with drama and malingering quite unlikely. She isn’t in any severe distress, but she clearly is not normal. She can answer some questions, and keeps saying she doesn’t “feel good.”

“She reminds me of people with brain bleeds,” I whisper to my partner.

“Yeah, I know.”

The ones I have seen were all vague and difficult to describe, and they behaved somewhat similarly, if they were awake at all.

Not much history available, but her co-worker finds her primary care physician’s number. For some reason, I call him after I take care of all my business. I don’t know why, but I guess I just want to know about her medical history and psychiatric history, if she has any, not that I really think she does, but more unexpected things I have seen. If there’s anything House teaches anyone, it’s that every aspect of a patient’s history is important, especially if you don’t know any.

Surprisingly, her physician picks up the phone before we arrive at the hospital. I explain to him that we have his patient here ALOC without any obvious cause, and I just want to ask him a few questions about her prior history. Somehow that leads to him babbling on and on for 3 minutes straight about absolutely nothing important, and finally I have to cut him off.

“Doc, I just need to know what her medical and psychiatric history is, and whether or not she has had similar events in the past.”

“Well, there’s nothing I can think of that would lead to this. Did you check her blood sugar yet? Because that’s what I would be thinking. If her blood sugar is low, that may cause her to behave differently. You guys can do that right?”

Fucking duh.

What a waste of time.

I am never calling anyone’s physician again. Ever.

8 thoughts on “Not doing that again”

  1. I’ve never been tempted to call a patient’s PCP when we’re on a call. In the few cases where the family has called the PCP after we arrived or the PCP called the patient, my experience has been much like yours. I can’t think of any case where it’s been helpful to me.

    I had one case where the PCP was at the same social function as his patient. His contribution was to grab the ECG out of my hand, look at it, and tell me it looked like an infarction to him. I turned the strip right side up and asked him if that looked better. He told me to “just take the patient to the hospital” and went back to his drink.

  2. It is really sad that this is the current state of affairs. I have had many PCPs say things that just leave me speechless due to the ignorance and lack of intelligence that it insinuates.

    We had one lady that had a 2 tonne hay bail fall on her and her friends drove her into a clinic, 10/10 pain everywhere. The physician there x-rayed her wrist and sent her home. When the patient couldn’t walk from the wheelchair to the car, friends called 911. We transported, hospital x-rayed her thorax, abd, and pelvis (incredible stroke of genius, I know!). 7 fractures to her pelvis.

    And the clinic doc was going to send her home with ibuprofen.

      1. Haha, maybe! It was actually more so due to the fact that crappy doctors go work in clinics and the good ones work in hospitals.

        Either way, she is going to have a bunch of surgeries, treatments, and medications, and the only thing she will have to pay for is her crutches.

  3. Something like the “wrist X-ray” story happened to my Dad–he wrecked riding his bicycle and went to an ED in a large city. The doc didn’t speak English well. Somehow he got the idea that the only thing to X-ray was the ankle, which turned out to be a sprain. Dad’s leg kept hurting and swelling for a couple of weeks and finally he went to an orthopedist who X-rayed the KNEE, finding the fractured tibial condyle.

    I hope the lady with altered medical status is OK, sounded like a brain bleed to me too.

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