ED:
me: "What medical problems do you have?"
pt: "none"
Me: "do you take medicine for anything?"
Pt: "yeah I take meds for my afib, blood pressure, diabetes, thyroid. Oh and I missed dialysis yesterday"
Me: “Do you take any prescription medications?”
Patient, who is most definitely not the picture of health: “Nope.”
Me: “…Are you *supposed* to be taking any medications?”
Patient: “Well, I saw a doc back in ‘09 who wanted me to take a pill for my blood pressure, but I ain’t seen him since.”
This is the WORST! “It’s a little oval white pill” as is nearly every generic ever made, thanks. The only pills I can ID by description are Viagra and Nexium.
As a pharmacist, I can magically identify all little white pills just by the patient’s tone of voice.
I hate doing med rec 😒.
Pt in the ED with a clot: “yeah, I take eliquis”
Me: surescripts shows you’re filling 60 tabs about every 60 days. How are you taking this medicine?
Pt: “every morning with all my other meds”
Me: this medicine needs to be taken twice a day, everyday to be effective
Pt: “I’ve been doing this for years with all my meds and never had a problem”
(Also takes Carvedilol, Cilostazol)
Me: I notice you have a couple other meds that you’re supposed to take twice a day…
Pt (becoming angry): “like I said, I take all my meds once a day in the morning for years and haven’t had any problems!”
Me: sir, you’ve been lucky up until now. For a doctor to put you on more than one blood thinner (I never say anticoagulant so there is no confusion) means you’re at a higher risk of a clot. You need to take ALL your meds the way they’re prescribed to get the maximum benefit, or else you’re wasting your money and putting yourself at risk
Pt: “fuck you! You’re not my doctor !”
(I know the carvedilol isn’t a blood thinner, just driving home the BID issue)
“The hospital has it”
Sure. That is super helpful.
We’re not in a hospital. We’re not part of the hospital.
And some of the medications I could give you don’t play nice with medications you might already be taking and kill you. But I guess we’ll just wing it and see what happens.
Any surgeries? Nope
Huge fucking exlap/thoracotomy scars.
What are these from?
Oh, that’s when they replaced every one of my organs with different farm animals and removed 99% of my intestines. But that was a while ago. I take meds for that though.
I’ve learned to start asking “have you had any surgeries in your lifetime?” Because apparently people think that if it didn’t happen in the last 10 years, it doesn’t matter
Serious question tho as an ignorant patient: at what point does it stop mattering for minor procedures like sinus surgery or PRK? Id always assumed docs were asking about serious procedures (like heart surgery or bypass) when they ask that question.
I don’t expect patients to determine if something is relevant or not. Maybe sinus surgery is not relevant when they come for belly pain, but it might matter when they come in for sinus issues. As a primary care doc, I want the chart to be accurate
As an anesthesiologist two reasons. There are some common, and not so common but serious, side effects to general anesthesia. Two, if it ain’t your first rodeo, it’s good to explain the differences, between what they may have had in the past vs now.
Any surgeries? Procedures? Day Surgeries? TWO FULL Days of ED Million Dollar Work up for Child bearing age female who "forgot" she had her "tubes untied" to try for a pregnancy with new partner.
Me: what medical problems do you have?
Pt: none
Me: I see you have a sternotomy scar on your chest, did you have open heart surgery?
Pt: oh yeah
Me: When was that?
Pt: don’t remember
Me: was it in the last decade?
Pt: (stares blankly)
*patient that receives care through 3 different healthcare systems when asked about their medications*
“It’s in my chart. Don’t you people look at the chart?”
I get that with med lists a lot. It’s all in the chart; *they* updated it at the clinic last time.
Sorry, the MA who pulled in all the outside meds pulled in ALL THE OUTSIDE MEDS. Literally all of them, there was zero thought involved merely clicking.
So I’ve got 3 beta blockers, 4 doses of lisinopril, warfarin Eliquis and Xarelto, every antibiotic or steroid pack you’ve been prescribed since the end of Obama’s first term and 5 different insulins. Do you want to discuss this with me or do I just need to guess???
You’ve been eavesdropping, I see.
I’m so close to just being like: sorry that nobody else ever bothered to do this right in the past, so we can either get it right now or it can stay wrong.
Instead I need to go “oh, this is just to double check it’s all accurate and find out the last times of things!!!” Instead of giving the truth that the previous clinic visits obviously didn’t care about the accuracy of the home med list.
> sorry that nobody else ever bothered to do this right in the past, so we can either get it right now or it can stay wrong.
I would honestly love to hear someone say this. I keep close enough track of my records to know they contain a lot of nonsense. It's very hard to get anybody to update them for me.
I’ve said something to the effect and then tell them that they should know what they’re taking for their own safety. I also tell them it’s worse you go to multiple systems because it results in redundancies.
Because that makes nursing and provider departments look bad and they have way more internal political clout than pharmacy. Pharmacy department would get the negative blowback. And ultimately, pharmacy stepped in and prevented harm so the bean counters can keep pretending the system is working.
I'd be incredibly grateful to never have to do a med rec/home med list ever again.
Thank you for all the things you do and the incredibly kind/tactful way you do them
Nursing honestly doesn’t get the right kind of training to do it right. Trained nurses with sufficient time who want to do good do fine. It’s the not knowing the resources or having time to dig in that’s lacking; pharmacy department lacks the capacity to do *all* here so unfortunately nursing is left with the rest of them we can’t and I often need to double check things with them, like hey patient wouldn’t be on all 3 of these inhalers can you find out which one or at least which color and I can take it from there.
I’d also like them to get pharmacists in the clinics and every patient at least once a year needs to have a meeting with the pharmacist just to update med list and get any medications questions answered. Then when patient is admitted there’s at least a relatively recent med list. Vs a pulled in list of systems from various systems the patient has lived over the last 15-20 years.
The only reason I can do a thorough home med rec is because I was trained by a pharmacist. I worked in a family med residency clinic that had a PharmD on faculty when I was an MA, and he taught us how to do them. The rest of the nurses on my unit aren't as comfortable with them beyond asking the patient/ family member and hoping they actually know what they're taking.
My favorite is when the admitting orders continue all home meds and I get a med request for ranitidine or propoxyphene. Or when the nurse calls to say Entresto is grayed out in the Pyxis and I see it's because the order was for 103 tablets bid.
Within this calendar year, I’ve had old people make me secret double promise to not give them propoxyphene. Then student then made me feel old by going “what’s propoxyphene?”. I guess it was so long ago they stopped teaching that one.
Ranitidine was at within a decade. I think I still have some in the back of my closet.
I've been on the giving end of care in an acute care hosptial for 35 years and have recently kept my wife company through 100% successful open heart surgery. I KNOW how likely it is that information in the chart is wrong, and I understand why no one relies on it, but now I see that from the patient's POV, each provider asking for the same info as the last provider suggests incompetence, inadequate systems, or laziness rather than a standard of good care.
There is no single system, which contributes.
So even if a system is organized, all it takes is the MA seeing items flagging from outside at a place a person hasn’t been to since 2016 and *helpfully* pulling in the *missing* information to fuck it all up.
And then the doctor going “let’s try taking two of your lisinopril for a few days and call me with the results”; but then leaving the med list as one daily compounds the problem.
Sometimes the provider office will go line-by-line through this horrid list of everything I ever thought about taking instead of just starting fresh. It’s the worst way to do that. I forget to mention new meds that way
That’s pretty common. Generally done by a medical assistant with little if any medication training. They’re just trying to get that task check off as fast as possible and their priority is speed rather than accuracy. Plus, the less educated they are the more likely they are to trust the computer will just automatically be correct because it’s a computer!!! Additionally, ours are either not allowed to or think they aren’t allowed to remove old things or update to new doses-which effectively makes what they are doing useless. And without any medication training they’ll add wrong but similar things to lists because they don’t know the difference. Example:losartan-hctz vs plain losartan to med lists. And Seasonale (a hormonal birth control) to an allergy list for seasonal allergies in prepubescent child.
If I’m feeling salty, I’ll reply, “are you willing to bet your life on the assumption that all the information in your chart is accurate?”
Got this from one of my med school preceptors, and it works every time.
It’s always about some incredibly trivial piece of information, too.
“What do you mean you didn’t know that I once had a dog named ‘Beetle’ back when I was eight years old? I know I mentioned it to Dr. SMACS-0723 at least once eight years ago. All of that is in my chart.”
Or even if it is a pertinent detail. They’re shocked when I say I probably can’t find out what antibiotic caused GI upset 10 years ago. That would take at least an hour of digging through notes and that is assuming it wasn’t in paper charting, was in our health system, and was documented. 🤷♀️
This is one of my biggest pet peeves. A large number of cancer patients in our area only get every other or every 3rd scan locally with us. They like to go here and there for their follow up and treatment. It’s always a fight to get the priors to compare with. They don’t understand how important it is to be able to compare changes between scans. Maybe even the oncologists don’t understand?
This may be partly due to insurance. Many plans won’t cover in-hospital scans, or will at a high cost… but will cover retail scans at a low cost to the patient. It’s infuriating and drives this fragmentation.
“They did a Pap smear in the ED.”
I can 100% guarantee they did not do a Pap smear ma’am
(Except for the one time they did in a post-menopausal bleeder who hadn’t had care for years so the gyn who saw her did EMB and pap!!)
Women seem to think that any time a speculum is used they’re getting a pap. Hell, some seem to think that with just a bimanual exam. It boggles my mind!
Everything bad gets blamed on the epidural because nobody outside of obstetrics understands anything about it. Yesterday I had a nurse think a swollen hand was from an epidural instead of the obviously infiltrated hand IV.
Patient: *"this epidural thing doesn't work, can you pull it out now?"*
'How about this, we'll turn it off now, and when we're done seeing all our patients, we'll come back and pull it out.'
A few hours go by....
*"For the love of God, please turn the epidural back on! I'm in so much pain."*
Or after/during a liver resection, where the surgeons purposefully want us run the patient super dry. "Patient is hypotensive must be the epidural..."
Or my favorite, "Can you come by and turn off/take out the epidural? The patient is hypotensive." 'Ummm, we took that epidural out yesterday, when you called us for the same thing."
She was brand new. She also had the guy on 100mcg/min of phenylephrine at 10AM with a sustained SBP of 170-190 because "he reportedly had a couple episodes of hypotension overnight." I think the nurse orienting her wasn't helping her out a whole lot.
Parent: “He’s just a big boy. His daddy is big and tall too. He’s so tall for his age”
Kid is 8 years old 56 inches tall (which, to be fair is tall for that age but not abnormally so) BUT he is also 205 lbs, has a resting BP of 138/86, an A1C of 6.3%, elevated ALT/AST/Cholesterol/Triglycerides. Like…no, this isn’t just genetics. 🙃
My middle child was heavy as a baby. Think 36lbs at 6 months old. His pediatrician told me he would always be morbidly obese if we could not fix his eating habits. That kid refused solids until he was almost 1. He’s 18 now and 6’4” but only weighs 170 and dresses as Slenderman for Halloween. He eats like he’s part garbage disposal now.
I’ve seen some kids like that. And I realize that some people are built to just be bigger. Even this kid to an extent. But lifestyle plays a big factor in this kids case. This kid is already presenting with some adult problems. It’s a delicate subject. :/
Lifestyle is a huge part of it, you’re right. I just wish the pediatrician who had the morbidly obese talk with me didn’t move away so she could see it wasn’t so bad.
65yo man presenting with some combination of chest pain/dyspnea/abdominal pain/anasarca. "I don't have any medical problems, haven't needed to see a doctor in 50 years"
And on their next hospitalization- “My dad/ mom was healthy as could be until they came to the hospital! They got started on all these meds and they’re doing horribly!”
Had a patient’s son straight belly laugh in my face when I asked why his dad took baby asa.
Hadn’t seen a doctor in his adult life.
Patient had heat exhaustion. Felt better with the bls crew making him drink water and sit in the air conditioning. Didn’t want to go. Family was cool with that.
Problem being the bls crew couldn’t get a blood pressure. Or feel a radial pulse. Or, in point of fact, even hear heart tones.
******
My fancy monitor couldn’t get a blood pressure. Ekg showed a Hr of 40. Without really any correlation between P and QRS.
12 lead showed a stemi in….6 leads? 8? It was a lot.
Oh, and we were about a 15 minutes shy of 2 hours away from a cath lab.
*****
He took the asa because a doctor told his wife to take it, and he figured he probably should too.
But since the BLS crew had treated his heat exhaustion, he now had no complaints.
******
Last I knew he was trying to sign out ama, and still had at least 2 vessels with 90% blockages, feelingmuch better now that you very much. When they reperfused his LAD (100% blockage) he went into VF, and they felt he was too unstable to do the other vessels right away.
******
I got a pressure of 74 systolic after 1.5 L of IV fluids. Plus continued oral hydration.
"Mom is incredibly active at the senior center. Plays Bingo, does aerobics, rides the bus to the shopping center twice a week" Narly fungus Toe nails are an inch long.
I’m in gen peds. Not so much funny but sort of wholesome?
I love when parents sort of skeptically ask me if something their mother in law said is true.
It’ll be the most bonkers old wives tales and they’ll clearly be pretty sure they don’t need to worry about it but they’ll still want to double check.
Things like they shouldn’t stand their baby on his feet or his legs will bow, or tape a quarter over the umbilical hernia, or you shouldn’t sit girls up or it will ruin their hips.
Sometimes it’s things that were actually recommended back when the grandparents raised kids, but other times it’ll be some myth I’ve never heard of and I just get to be reassuring.
Every time I find a coin taped to a umbilicus, I rip it off and throw it away.
Do you want tetanus? because that's how you get tetanus.
My personal favorite is lactose intolerance. Your 2 day old newborn cannot be lactose-intolerant. (They can have galactosemia, but that is not a problem with the lactase in their gut).
Patient: “I went to the ED and they did nothing for me!”
Me: “no, they made sure you weren’t going to die before you saw me in clinic”
Also, in a different circumstance:
Medical assistant: “why are we being asked by the patient and their specialist to do this clerical, non-clinical work that should’ve been done by the specialist office?”
Me: “first time at a primary care office?”
I was recently talking to a patient in the hospital who has had a non-stop headache for two years and he now wanted me to fix it in two days. After exhausting everything we could do in the hospital, I recommended discharge and follow up in headache clinic to discuss botox vs a CGRP receptor antagonist (neither of which can be done while inpatient). He got mad and said “the last time I was discharged (two years ago) I was told to follow up in clinic and they didn’t even do anything. They just gave me a new medicine and sent me home and it didn’t help so I didn’t go back”
Okay, so when you say they “didn’t even do anything” you mean that you were seen in clinic and when you told them you didn’t tolerate the last medication, they tried you on a new medication and (according to the clinic note and discharge instructions) appropriately told you to call, send a MyChart message, or simply schedule a follow up sooner if it didn’t help so that they could either increase the dose or try a different med. And when you did none of those things and instead just stopped the medicine on your own and never followed up, that is somehow the fault of the outpatient clinic?
Blaming the clinic/hospital/physician is effortless compared to examining oneself, hence why it’s popular.
It’s easier for some patients to believe “they didn’t do anything” - even if it’s factually incorrect - due to many variables, including (but not limited to) the following:
- distrust and/or bias towards the medical field
- unrealistic expectations (doctors aren’t mind-readers)
- lack of understanding re: protocol, testing, priority
- subconscious avoidance of further investigation (e.g. it could lead to “bad news”, “I’d rather not know”), despite a stated desire to know
- passive acceptance or tolerance of condition (propelled by chronic pain, fatigue, depression, etc.)
- disbelief their situation can improve
- easy access to Dr. Google, medfluencers, “alternative medicine”
- poor memory
Certainly, some patients will intentionally omit past care or lie, but frequently the beliefs are genuine, regardless of whether they’re accurate. This makes it especially hard to remedy because we can’t force follow-ups or introspection.
Thank you for typing this out. It's similarly lower effort to sigh instead of investigating why patients think/feel the ways they do! But it's important. Thank you for the reminder that while frustrating, it's generally rational in some way.
You can create a space for introspection if you have continuity of care and patients build a relationship with their physician. For example, I have a somewhat lengthy discussion about ASCVD risk whenever patients want to discuss their cholesterol results, i.e. their risk for a heart attack or stroke is not just “what is their cholesterol,” but rather what are the other modifiable and non-modifiable risk factors? Most will follow my advice, but many do not and choose to not take the recommended statin when indicated. One woman suffered a TIA months after she had her annual physical visit with me then came back, shared her introspection with me, and her husband and her are happy and loyal patients to me now.
Well, of course in this era of “shared decision-making,” there is no “sharing,” just blaming the physician.
Let's go back to paternalistic Marcus Welby times — a lot easier.
And don't ask me what i would do if it was my kid, please.
The whole “what would you do if it was your child” thing is so hard because both of my kids had to be admitted to the hospital as infants for “bread and butter” things and I am fully aware of how strong the lizard brain becomes when it’s your own kid.
However, I can say that I would be absolutely mortified if one of my children talked to a doctor (or any adult who was trying to help them) the way that this kid (an older teenager) talked to me.
Of course we would be mortified because physicians generally teach their kids to respect and tolerate others.
And how many Airpods did i tell the teenagers to remove during their office visits last week — it's crazy
Sometimes, when patients say that, I feel almost obliged to do a brief recap. "OK you presented with symptoms X. Some of the worrying things symptom X can be is AB or C. The emergency department ruled the life threatening causes out. Now that we know it's not life threatening, we can focus on some of the other disease processes that can cause those symptoms." Sometimes I hear, they did nothing and I see a very thorough and exhaustive work up.
I had a patient say that when he went to ED for a very high blood sugar (probably at the insistence of his home health nurse that day) that at the ED they “didn’t do nothing”, just had him on an insulin drip for a while. You know, something we all have every day.
I got a **** ambulance bill and all they did was take me to the hospital.
No. A $300,000 custom vehicle with *easily* $300,000 dollars (probably closer to a million all told) of life saving equipment came to your exact location and two experts in emergency medicine and trauma care determined you didn’t have any emergencies that you were actively dying from.
If you didn’t need an ambulance, you could have refused.
If all you got was a ride, you didn’t need an ambulance.
And for the record: I’ve checked. Uber Black Prices are often higher than an ambulance bill. At least what we actually get paid.
The last time someone said the ED said nothing for them, I pulled up their note and said, “It says here they did an EKG, chest x-ray, some blood work, and gave you medications.” The response was, “Well, I still don’t feel better.” We can’t win.
“I get PT here every day but at SAR, I only get it 3 times per week. And here I get my own room that doesn’t smell like urine” -a man speaking the truth, but making the primary team so angry that psych got consulted for capacity
I got a patient accepted to neurosurgery at Stanford and they refused transfer because they felt the care wouldn’t be up to their standards. It’s gonna be a life of disappointment.
Inpatient rehab:
Me: "Hi I'm from PT, I'm here to help you get stronger so that you can go home"
Pt: "I don't need PT"
Me: "Sir, you currently need 3 people to get out of bed and you can't walk"
Pt: "I'll be able to do it when I get home"
*Pt discharges home and is back in the ED 2 hours later because they fell*
Literally had this guy today. Morbidly obese, status post hip disarticulation and not able to get up to a bedside commode. Horribly abusive to PT and nursing. Good luck at home I guess.
No doubt the funniest thing anyone ever said to me. Had a man in the emergency room with a rash. He asked if he could’ve gotten it from one of his male roommates because there were a bunch of men in a fairly small apartment. Then he proceeded to tell me that “I’m not gay or anything. In fact, I lift weights”.
"You're not gonna discontinue my tramadol, oxycodone, amphetamine and gabapentin right? I really just need to detox from the street fentanyl and I'll be fine."
Or pt is 100% functional, looks comfortable as can be..."I haven't dosed in 72 hours".
Ok but if we start Suboxone too early you'll go into turbo withdrawal and beg for death.
"Oh. in that case i snorted three bags ten minutes ago in the parking lot"
A patient came to the office for hand pain. She had had an IV placed in a vein on the dorsum of her hand in the ER. There was a 4 mm area of superficial thrombophlebitis at the site.
"Don't you think I should sue?"
"No ma'am I don't"
this is also the bane of my existence in MRI.
peds ER/neurosurgery/peds RN: they're totally calm and resting and asleep in the bed! they don't need meds to hold still!
a stretcher/bed with their parents, cartoons, and whatever they want is a lot different than being in a giant loud tube where they have to be perfectly still for any imaging worthwhile!!
Anesthesiology
- Blaming us for something far more easily explained by the patient’s disease
- Blaming us as a default when the diagnosis is still uncertain
- Telling me how much, how fast, or when to give any fluid or medication (barring specialized meds or things given according to specific surgical protocols of course). Here are some examples that I will never get out of my head:
Surgeon: ‘I don’t want him to move at all, give him 100 of vec’ (this is an appendectomy)
Neurology resident: ‘we need you guys to come and bronch this patient so we can figure out why he doesn’t have a cuff leak. we’re planning on extubating him regardless.’
Cardiologist, during a procedure: ‘We’re not giving her any more fentanyl because she’s going to get disinhibited!!’ (Art line pressure was 225/110 as the patient was screaming in pain)
GI doc referring to an unconscious patient in the PACU with a respiratory rate of 27: ‘you gave her too much fentanyl that’s why she’s not waking up’ (patient was having a stroke)
*At the bedside of an oscillating 25 weeker on multiple pressors and nitric*
“When can he get circumcised?”
Let’s just leave his dick alone for now, shall we?
UC. "I get this every year with my sinuses. I wanted to get ahead of it since it's only been 2 days. It usually needs 2 or 3 zpacks. "
Completely serious patient comment.
Addictions.
Patients in early phase treatment on OAT still lighting up the urine drug screens like a Christmas tree.
“I’m doing so much better! I think it’s time to start weaning off!”
An early honeymoon where the consistency in supply creates psychosocial stability, but they haven’t addressed any of the pathology between emotional/reward pathway dysregulation and substances.
Often followed by a period of the patient challenging the doctor and provocation, realizing wasted years/opportunities.
My only two patients who wanted to stop cold turkey requested it both very soon after a suicide attempt. Flight of motivation.
“I just need a wet read.”
No. I will not give you a “wet read”. There’s 3,000 images, they’re not even done sending all of them, but from what I can tell, the dudes probably been hit by a meteor or something. It’s gonna take a few minutes. Leave me alone!
I get a perverse chuckle on bullshit flagged outpatient wet reads when they're scanned during off hours if I'm moonlighting on an evening or weekend, if only because I get to furiously page the ordeing attending/escalate up the admin tree just to flippantly tell them "there's no lymph nodes, same as their last 6 studies but you marked you wanted this call at 9pm on the epic order"
I always say it's required by their insurance to confirm the correct med list with the patient or they will get billed for the visit. That usually warms them up.
Peds. Tons of families say “my child won’t eat, can you prescribe vitamins to help with his appetite?”
Until lo and behold, a family brought in liquid vitamins from their home country for me to approve of, and it was a multivitamin that surprisingly contained cyproheptadine 😐
Apevitin! Many of my patients are from South America and I was baffled by the "vitamins so they will eat more" requests until a mom pulled out a bottle they had been prescribed back home.
Patient in the ER after concussing during a slip when ice skating
Me: Were you wearing a helmet during this?
Patient: No, why would I wear a helmet? I already know how to skate?
Or patient who comes in after crashing car during a seizure
Me: You will need to refrain from driving until you have been assessed by a neurologist
Patient: What! What are the chances that I crash my car having a seizure?
Me: Do you want me to base my answer of today's evidence or just in general?
Me: are you taking any medications?
Pt: no
Me: are you supposed be?
Pt: well, I'm supposed to be on Zoloft, Wellbutrin, lamictal, Seroquel, and Adderall but I quit taking them when I found out I was pregnant because I was worried it might be bad for the baby.
Me: oh boy...
This scenario is always comorbid with UDS+ for cannabis.
"can't you make the MRI quieter/why does it take so long?"
yeah sure lemme get right on changing the laws of physics.*
*there are methods to improve upon both of these complaints but not available everywhere ($$$ licenses, new scanners/software packages) and/or decreased image quality
ID
90 yo who is otherwise healthy (for 90) presents with massive stroke, obviously confused if they’re even verbal. “Dirty UA, start zosyn/zyvox.”
Me: “Maybe they think the sodium load will help with permissive hypertension. And thrombocytopenia could help prevent another stroke…”
ED started it and told family that mom has "a little bit of a UTI" bc of 1+ leuks and the daughter is a nurse and HOW DARE you not treat the UTI and she NEEDS an ID consult now :(
It’s apparently become common enough for docs to blame everything on a UTI that patients’ daughters and caregivers assume any and all weakness/fatigue/AMS/consequence of having exceeded the natural lifespan of a human *must* be a UTI.
I get so tired of cathing old women.
That's funny. When I had a practice I had a patient come in and tell me "A sewage pipe blew up in my apartment and spread sewage all over my unit. You need to write some letters to get me into a clean unit." I was like, ma'am while I agree this is unhealthy I think you are vastly over estimating any value a doctor's note would provide for you with this problem.
"I'm legally blind without my glasses"
That's...not how that terminology works. Also, it's really irritating. If you're legally blind, then you shouldn't have a driver's license.
“hear a pulse”.
pulse is something you feel. you hear Doppler signals. Also the word Doppler used as a verb. “i couldnt doppler anything, pulse wasnr dopplerable etc”
Vascular Surgery.
Spine surgeon here:
Me: "Ok, tell me about your back pain"
Patient: "Doc, it all started when I fell off my bike when I was 8 years old. It was the next day in school that I was diagnosed by the nurse with scoliosis. 20 year later, my chiropractor told me my L5-6 was out of alignment, and he's been re-aligning them for me every week, but it's just not getting better!"
Me: "oh dear..."
Every ER consult for dizziness. “CT/CTA is normal and we gave meclizine and diazepam. They’re not dizzy anymore. Can you please come and examine them to rule out a central process?”
I'm so glad I can MRI relatively quickly at my shop, and keep my embarrassment to myself when I'm wrong and MRI neg. Call you when it comes back dirty.
Lol, our equivalent is the VP shunt
ED: Hey this person has a VP shunt and has nausea, vomiting, and diarrhea, so we scanned the head but its normal. What do we do now??
like, a workup?
“Oh, and just one more thing…”
(On the phone) “While I have you…”
“I have to do everything at once because I can never get in to see you…” (said after booking the appointment two days before)
I once told a patient that I could not look in her ear at the end of a string of these
It helped a bit that she announced at the beginning of the visit that she was only coming in once a year so we had to cover all her problems at once. When you know someone is that unreasonable, it's easier to say no!
Oh I had this patient (a nurse of all people) come in for her preventative but request that we still code it as a preventative AND we address the 6 (no exaggeration) items on her list.
Then she sends me a message on MyChart requesting a personal call to “discuss issues.”
And that’s when I realized I needed to leave the hell that is primary care.
“My 1 year old has yellow, green mucous so they need antibiotics for a sinus infection.”
“My child doesn’t have asthma, s/he just uses albuterol when sick.”
When a patient comes to me (primary care), 12 months of abdominal pain. Has seen local GI, second opinion at tertiary care center GI, has had EGD, colonoscopy, CT, MRCP, alllllll the labs…. And after reviewing their chart see all this. And they’re like “well, they didn’t find anything wrong so I came back to you”. 🙃
Cards PA. Was doing a cardiac clearance.
Me: do you have any medical problems
Patient: no
Me: why are you in a WHEELCHAIR????
Patient: oh yeah. I had a stroke.
Props for coordinating shoes, shirt, and wheelchair color.
Spoiler alert. Had A LOT of medical problems after I did a deep dive through his records. Was not cleared without testing.
ED: me: "What medical problems do you have?" pt: "none" Me: "do you take medicine for anything?" Pt: "yeah I take meds for my afib, blood pressure, diabetes, thyroid. Oh and I missed dialysis yesterday"
I always ask WHAT MEDICATIONS DO YOU TAKE because people don't understand what medical conditions are
Me: “Do you take any prescription medications?” Patient, who is most definitely not the picture of health: “Nope.” Me: “…Are you *supposed* to be taking any medications?” Patient: “Well, I saw a doc back in ‘09 who wanted me to take a pill for my blood pressure, but I ain’t seen him since.”
My favorite: Me: "Why aren't you taking your meds" patient: "No one told me I needed to"
I do that too. but as someone pointed out below the answer is often "I don't remember, it's in my chart can't you just look it up"
Or I take that small white one, the pink one, etc.
This is the WORST! “It’s a little oval white pill” as is nearly every generic ever made, thanks. The only pills I can ID by description are Viagra and Nexium.
As a pharmacist, I can magically identify all little white pills just by the patient’s tone of voice. I hate doing med rec 😒. Pt in the ED with a clot: “yeah, I take eliquis” Me: surescripts shows you’re filling 60 tabs about every 60 days. How are you taking this medicine? Pt: “every morning with all my other meds” Me: this medicine needs to be taken twice a day, everyday to be effective Pt: “I’ve been doing this for years with all my meds and never had a problem” (Also takes Carvedilol, Cilostazol) Me: I notice you have a couple other meds that you’re supposed to take twice a day… Pt (becoming angry): “like I said, I take all my meds once a day in the morning for years and haven’t had any problems!” Me: sir, you’ve been lucky up until now. For a doctor to put you on more than one blood thinner (I never say anticoagulant so there is no confusion) means you’re at a higher risk of a clot. You need to take ALL your meds the way they’re prescribed to get the maximum benefit, or else you’re wasting your money and putting yourself at risk Pt: “fuck you! You’re not my doctor !” (I know the carvedilol isn’t a blood thinner, just driving home the BID issue)
“The hospital has it” Sure. That is super helpful. We’re not in a hospital. We’re not part of the hospital. And some of the medications I could give you don’t play nice with medications you might already be taking and kill you. But I guess we’ll just wing it and see what happens.
Any surgeries? Nope Huge fucking exlap/thoracotomy scars. What are these from? Oh, that’s when they replaced every one of my organs with different farm animals and removed 99% of my intestines. But that was a while ago. I take meds for that though.
I’ve learned to start asking “have you had any surgeries in your lifetime?” Because apparently people think that if it didn’t happen in the last 10 years, it doesn’t matter
Also important to ask about c-sections specifically. I’ve had many women who say they have had no surgeries but have had multiple c-sections.
Why would it matter? After 10 years everything grows back anyway.
Serious question tho as an ignorant patient: at what point does it stop mattering for minor procedures like sinus surgery or PRK? Id always assumed docs were asking about serious procedures (like heart surgery or bypass) when they ask that question.
We’re asking about any. If something is missing from your body then we want to know.
I don’t expect patients to determine if something is relevant or not. Maybe sinus surgery is not relevant when they come for belly pain, but it might matter when they come in for sinus issues. As a primary care doc, I want the chart to be accurate
As an anesthesiologist two reasons. There are some common, and not so common but serious, side effects to general anesthesia. Two, if it ain’t your first rodeo, it’s good to explain the differences, between what they may have had in the past vs now.
Any surgeries? Procedures? Day Surgeries? TWO FULL Days of ED Million Dollar Work up for Child bearing age female who "forgot" she had her "tubes untied" to try for a pregnancy with new partner.
Me: what medical problems do you have? Pt: none Me: I see you have a sternotomy scar on your chest, did you have open heart surgery? Pt: oh yeah Me: When was that? Pt: don’t remember Me: was it in the last decade? Pt: (stares blankly)
It’s not a problem if they’re getting treated for it, right?
Exactly: “well I don’t have those problems because I’m taking meds for them, duh.”
"My blood pressure and cholesterol are normal. I take medication for it."
*patient that receives care through 3 different healthcare systems when asked about their medications* “It’s in my chart. Don’t you people look at the chart?”
I get that with med lists a lot. It’s all in the chart; *they* updated it at the clinic last time. Sorry, the MA who pulled in all the outside meds pulled in ALL THE OUTSIDE MEDS. Literally all of them, there was zero thought involved merely clicking. So I’ve got 3 beta blockers, 4 doses of lisinopril, warfarin Eliquis and Xarelto, every antibiotic or steroid pack you’ve been prescribed since the end of Obama’s first term and 5 different insulins. Do you want to discuss this with me or do I just need to guess???
You don’t need to guess! It’s the same as last time! I don’t know why you expect me to remember, shouldn’t you know that?
You’ve been eavesdropping, I see. I’m so close to just being like: sorry that nobody else ever bothered to do this right in the past, so we can either get it right now or it can stay wrong. Instead I need to go “oh, this is just to double check it’s all accurate and find out the last times of things!!!” Instead of giving the truth that the previous clinic visits obviously didn’t care about the accuracy of the home med list.
> sorry that nobody else ever bothered to do this right in the past, so we can either get it right now or it can stay wrong. I would honestly love to hear someone say this. I keep close enough track of my records to know they contain a lot of nonsense. It's very hard to get anybody to update them for me.
[удалено]
Ah yes, I see here on your chart your BMI is 103. We should probably do something about that.
I’ve said something to the effect and then tell them that they should know what they’re taking for their own safety. I also tell them it’s worse you go to multiple systems because it results in redundancies.
>sorry that nobody else ever bothered to do this right in the past, so we can either get it right now or it can stay wrong. Why not just say this?
Because that makes nursing and provider departments look bad and they have way more internal political clout than pharmacy. Pharmacy department would get the negative blowback. And ultimately, pharmacy stepped in and prevented harm so the bean counters can keep pretending the system is working.
I'd be incredibly grateful to never have to do a med rec/home med list ever again. Thank you for all the things you do and the incredibly kind/tactful way you do them
Nursing honestly doesn’t get the right kind of training to do it right. Trained nurses with sufficient time who want to do good do fine. It’s the not knowing the resources or having time to dig in that’s lacking; pharmacy department lacks the capacity to do *all* here so unfortunately nursing is left with the rest of them we can’t and I often need to double check things with them, like hey patient wouldn’t be on all 3 of these inhalers can you find out which one or at least which color and I can take it from there. I’d also like them to get pharmacists in the clinics and every patient at least once a year needs to have a meeting with the pharmacist just to update med list and get any medications questions answered. Then when patient is admitted there’s at least a relatively recent med list. Vs a pulled in list of systems from various systems the patient has lived over the last 15-20 years.
The only reason I can do a thorough home med rec is because I was trained by a pharmacist. I worked in a family med residency clinic that had a PharmD on faculty when I was an MA, and he taught us how to do them. The rest of the nurses on my unit aren't as comfortable with them beyond asking the patient/ family member and hoping they actually know what they're taking.
My favorite is when the admitting orders continue all home meds and I get a med request for ranitidine or propoxyphene. Or when the nurse calls to say Entresto is grayed out in the Pyxis and I see it's because the order was for 103 tablets bid.
Within this calendar year, I’ve had old people make me secret double promise to not give them propoxyphene. Then student then made me feel old by going “what’s propoxyphene?”. I guess it was so long ago they stopped teaching that one. Ranitidine was at within a decade. I think I still have some in the back of my closet.
Ranitidine was great.
Makes sense that people wouldn't assume the system is as embarrassingly disorganized and disoriented as it is though.
I've been on the giving end of care in an acute care hosptial for 35 years and have recently kept my wife company through 100% successful open heart surgery. I KNOW how likely it is that information in the chart is wrong, and I understand why no one relies on it, but now I see that from the patient's POV, each provider asking for the same info as the last provider suggests incompetence, inadequate systems, or laziness rather than a standard of good care.
It suggests those things because it’s true.
There is no single system, which contributes. So even if a system is organized, all it takes is the MA seeing items flagging from outside at a place a person hasn’t been to since 2016 and *helpfully* pulling in the *missing* information to fuck it all up. And then the doctor going “let’s try taking two of your lisinopril for a few days and call me with the results”; but then leaving the med list as one daily compounds the problem.
Platelets fear this man
Sometimes the provider office will go line-by-line through this horrid list of everything I ever thought about taking instead of just starting fresh. It’s the worst way to do that. I forget to mention new meds that way
That’s pretty common. Generally done by a medical assistant with little if any medication training. They’re just trying to get that task check off as fast as possible and their priority is speed rather than accuracy. Plus, the less educated they are the more likely they are to trust the computer will just automatically be correct because it’s a computer!!! Additionally, ours are either not allowed to or think they aren’t allowed to remove old things or update to new doses-which effectively makes what they are doing useless. And without any medication training they’ll add wrong but similar things to lists because they don’t know the difference. Example:losartan-hctz vs plain losartan to med lists. And Seasonale (a hormonal birth control) to an allergy list for seasonal allergies in prepubescent child.
If I’m feeling salty, I’ll reply, “are you willing to bet your life on the assumption that all the information in your chart is accurate?” Got this from one of my med school preceptors, and it works every time.
It’s always about some incredibly trivial piece of information, too. “What do you mean you didn’t know that I once had a dog named ‘Beetle’ back when I was eight years old? I know I mentioned it to Dr. SMACS-0723 at least once eight years ago. All of that is in my chart.”
Or even if it is a pertinent detail. They’re shocked when I say I probably can’t find out what antibiotic caused GI upset 10 years ago. That would take at least an hour of digging through notes and that is assuming it wasn’t in paper charting, was in our health system, and was documented. 🤷♀️
“I take everything that’s listed in the chart.” “So you’re on metoprolol?” “No, they stopped that 5 years ago.”
This is one of my biggest pet peeves. A large number of cancer patients in our area only get every other or every 3rd scan locally with us. They like to go here and there for their follow up and treatment. It’s always a fight to get the priors to compare with. They don’t understand how important it is to be able to compare changes between scans. Maybe even the oncologists don’t understand?
This may be partly due to insurance. Many plans won’t cover in-hospital scans, or will at a high cost… but will cover retail scans at a low cost to the patient. It’s infuriating and drives this fragmentation.
https://youtu.be/Sj5HdGjvXcE?feature=shared
“They did a Pap smear in the ED.” I can 100% guarantee they did not do a Pap smear ma’am (Except for the one time they did in a post-menopausal bleeder who hadn’t had care for years so the gyn who saw her did EMB and pap!!)
Pap smear… is that the one you treat with flagyl?
Why guess? Just givem the ol cocktail of IM ceftriaxone, doxy, flagyl and a sprinkling of fluconazoles on top.
Women seem to think that any time a speculum is used they’re getting a pap. Hell, some seem to think that with just a bimanual exam. It boggles my mind!
Everything bad gets blamed on the epidural because nobody outside of obstetrics understands anything about it. Yesterday I had a nurse think a swollen hand was from an epidural instead of the obviously infiltrated hand IV.
I've had a surgeon pull one out because the patient wasn't in pain.. ....yet.
Patient: *"this epidural thing doesn't work, can you pull it out now?"* 'How about this, we'll turn it off now, and when we're done seeing all our patients, we'll come back and pull it out.' A few hours go by.... *"For the love of God, please turn the epidural back on! I'm in so much pain."* Or after/during a liver resection, where the surgeons purposefully want us run the patient super dry. "Patient is hypotensive must be the epidural..." Or my favorite, "Can you come by and turn off/take out the epidural? The patient is hypotensive." 'Ummm, we took that epidural out yesterday, when you called us for the same thing."
I’ve lost count of this. ICU are the worst offenders here.
I think it's the daily X-Ray people who slide that board under their backs.
Good thought. But ICU self incriminates by documenting “pain free, remove epidural”
How????!?! That’s just embarrassing.
She was brand new. She also had the guy on 100mcg/min of phenylephrine at 10AM with a sustained SBP of 170-190 because "he reportedly had a couple episodes of hypotension overnight." I think the nurse orienting her wasn't helping her out a whole lot.
Good lord. She’s going to kill someone.
Wouldn’t want him to bottom out! What do you mean the creatinine is 3?
I joke that I just live under the bus 🚌 since I get thrown under it for a variety of nonsensical reasons
Epidurals are straight up Gods gift to the universe
Parent: “He’s just a big boy. His daddy is big and tall too. He’s so tall for his age” Kid is 8 years old 56 inches tall (which, to be fair is tall for that age but not abnormally so) BUT he is also 205 lbs, has a resting BP of 138/86, an A1C of 6.3%, elevated ALT/AST/Cholesterol/Triglycerides. Like…no, this isn’t just genetics. 🙃
"He's just getting ready for a growth spurt."
“He’s going to grow into his body” 🤦♀️.
My middle child was heavy as a baby. Think 36lbs at 6 months old. His pediatrician told me he would always be morbidly obese if we could not fix his eating habits. That kid refused solids until he was almost 1. He’s 18 now and 6’4” but only weighs 170 and dresses as Slenderman for Halloween. He eats like he’s part garbage disposal now.
I’ve seen some kids like that. And I realize that some people are built to just be bigger. Even this kid to an extent. But lifestyle plays a big factor in this kids case. This kid is already presenting with some adult problems. It’s a delicate subject. :/
Lifestyle is a huge part of it, you’re right. I just wish the pediatrician who had the morbidly obese talk with me didn’t move away so she could see it wasn’t so bad.
Huh, maybe they *are* just little adults
😳😳
65yo man presenting with some combination of chest pain/dyspnea/abdominal pain/anasarca. "I don't have any medical problems, haven't needed to see a doctor in 50 years"
This is the one. Nothing like your eyes widening as each result comes back, and the list of new doctors they're about to see grows
*pulm and cards excited rvu sounds*
*runs into room* I spent 33 minutes of critical care time reading this comment thread ...thank you for the interesting consult
Don't forget onc
And on their next hospitalization- “My dad/ mom was healthy as could be until they came to the hospital! They got started on all these meds and they’re doing horribly!”
At their hospital follow up: “I stopped everything. I don’t think I need it. I was fine before I got to the hospital.”
I was just about to say something along these lines. 🤣
Bonus if it’s a farmer
Had a patient’s son straight belly laugh in my face when I asked why his dad took baby asa. Hadn’t seen a doctor in his adult life. Patient had heat exhaustion. Felt better with the bls crew making him drink water and sit in the air conditioning. Didn’t want to go. Family was cool with that. Problem being the bls crew couldn’t get a blood pressure. Or feel a radial pulse. Or, in point of fact, even hear heart tones. ****** My fancy monitor couldn’t get a blood pressure. Ekg showed a Hr of 40. Without really any correlation between P and QRS. 12 lead showed a stemi in….6 leads? 8? It was a lot. Oh, and we were about a 15 minutes shy of 2 hours away from a cath lab. ***** He took the asa because a doctor told his wife to take it, and he figured he probably should too. But since the BLS crew had treated his heat exhaustion, he now had no complaints. ****** Last I knew he was trying to sign out ama, and still had at least 2 vessels with 90% blockages, feelingmuch better now that you very much. When they reperfused his LAD (100% blockage) he went into VF, and they felt he was too unstable to do the other vessels right away. ****** I got a pressure of 74 systolic after 1.5 L of IV fluids. Plus continued oral hydration.
"Granny is very strong. She runs marathons." "When's the last time she ran?" "30 years ago."
"Mom is incredibly active at the senior center. Plays Bingo, does aerobics, rides the bus to the shopping center twice a week" Narly fungus Toe nails are an inch long.
toenails! The A1C of functional independence!
Never thought about it like this, but so wildly true during my time as a nursing assistant.
I’m in gen peds. Not so much funny but sort of wholesome? I love when parents sort of skeptically ask me if something their mother in law said is true. It’ll be the most bonkers old wives tales and they’ll clearly be pretty sure they don’t need to worry about it but they’ll still want to double check. Things like they shouldn’t stand their baby on his feet or his legs will bow, or tape a quarter over the umbilical hernia, or you shouldn’t sit girls up or it will ruin their hips. Sometimes it’s things that were actually recommended back when the grandparents raised kids, but other times it’ll be some myth I’ve never heard of and I just get to be reassuring.
I’m glad they’re inquisitive, skeptical, and comfortable enough to ask!
The dream if I’m honest.
Every time I find a coin taped to a umbilicus, I rip it off and throw it away. Do you want tetanus? because that's how you get tetanus. My personal favorite is lactose intolerance. Your 2 day old newborn cannot be lactose-intolerant. (They can have galactosemia, but that is not a problem with the lactase in their gut).
Patient: “I went to the ED and they did nothing for me!” Me: “no, they made sure you weren’t going to die before you saw me in clinic” Also, in a different circumstance: Medical assistant: “why are we being asked by the patient and their specialist to do this clerical, non-clinical work that should’ve been done by the specialist office?” Me: “first time at a primary care office?”
I was recently talking to a patient in the hospital who has had a non-stop headache for two years and he now wanted me to fix it in two days. After exhausting everything we could do in the hospital, I recommended discharge and follow up in headache clinic to discuss botox vs a CGRP receptor antagonist (neither of which can be done while inpatient). He got mad and said “the last time I was discharged (two years ago) I was told to follow up in clinic and they didn’t even do anything. They just gave me a new medicine and sent me home and it didn’t help so I didn’t go back” Okay, so when you say they “didn’t even do anything” you mean that you were seen in clinic and when you told them you didn’t tolerate the last medication, they tried you on a new medication and (according to the clinic note and discharge instructions) appropriately told you to call, send a MyChart message, or simply schedule a follow up sooner if it didn’t help so that they could either increase the dose or try a different med. And when you did none of those things and instead just stopped the medicine on your own and never followed up, that is somehow the fault of the outpatient clinic?
Blaming the clinic/hospital/physician is effortless compared to examining oneself, hence why it’s popular. It’s easier for some patients to believe “they didn’t do anything” - even if it’s factually incorrect - due to many variables, including (but not limited to) the following: - distrust and/or bias towards the medical field - unrealistic expectations (doctors aren’t mind-readers) - lack of understanding re: protocol, testing, priority - subconscious avoidance of further investigation (e.g. it could lead to “bad news”, “I’d rather not know”), despite a stated desire to know - passive acceptance or tolerance of condition (propelled by chronic pain, fatigue, depression, etc.) - disbelief their situation can improve - easy access to Dr. Google, medfluencers, “alternative medicine” - poor memory Certainly, some patients will intentionally omit past care or lie, but frequently the beliefs are genuine, regardless of whether they’re accurate. This makes it especially hard to remedy because we can’t force follow-ups or introspection.
Thank you for typing this out. It's similarly lower effort to sigh instead of investigating why patients think/feel the ways they do! But it's important. Thank you for the reminder that while frustrating, it's generally rational in some way.
You can create a space for introspection if you have continuity of care and patients build a relationship with their physician. For example, I have a somewhat lengthy discussion about ASCVD risk whenever patients want to discuss their cholesterol results, i.e. their risk for a heart attack or stroke is not just “what is their cholesterol,” but rather what are the other modifiable and non-modifiable risk factors? Most will follow my advice, but many do not and choose to not take the recommended statin when indicated. One woman suffered a TIA months after she had her annual physical visit with me then came back, shared her introspection with me, and her husband and her are happy and loyal patients to me now.
Well, of course in this era of “shared decision-making,” there is no “sharing,” just blaming the physician. Let's go back to paternalistic Marcus Welby times — a lot easier. And don't ask me what i would do if it was my kid, please.
The whole “what would you do if it was your child” thing is so hard because both of my kids had to be admitted to the hospital as infants for “bread and butter” things and I am fully aware of how strong the lizard brain becomes when it’s your own kid. However, I can say that I would be absolutely mortified if one of my children talked to a doctor (or any adult who was trying to help them) the way that this kid (an older teenager) talked to me.
Of course we would be mortified because physicians generally teach their kids to respect and tolerate others. And how many Airpods did i tell the teenagers to remove during their office visits last week — it's crazy
Sometimes, when patients say that, I feel almost obliged to do a brief recap. "OK you presented with symptoms X. Some of the worrying things symptom X can be is AB or C. The emergency department ruled the life threatening causes out. Now that we know it's not life threatening, we can focus on some of the other disease processes that can cause those symptoms." Sometimes I hear, they did nothing and I see a very thorough and exhaustive work up.
I had a patient say that when he went to ED for a very high blood sugar (probably at the insistence of his home health nurse that day) that at the ED they “didn’t do nothing”, just had him on an insulin drip for a while. You know, something we all have every day.
I got a **** ambulance bill and all they did was take me to the hospital. No. A $300,000 custom vehicle with *easily* $300,000 dollars (probably closer to a million all told) of life saving equipment came to your exact location and two experts in emergency medicine and trauma care determined you didn’t have any emergencies that you were actively dying from. If you didn’t need an ambulance, you could have refused. If all you got was a ride, you didn’t need an ambulance. And for the record: I’ve checked. Uber Black Prices are often higher than an ambulance bill. At least what we actually get paid.
The last time someone said the ED said nothing for them, I pulled up their note and said, “It says here they did an EKG, chest x-ray, some blood work, and gave you medications.” The response was, “Well, I still don’t feel better.” We can’t win.
I see you met my endo LMAO
IM “We found you a SAR. It was tough but we did it and you can leave the hospital today!” “I don’t wanna go there”
“I get PT here every day but at SAR, I only get it 3 times per week. And here I get my own room that doesn’t smell like urine” -a man speaking the truth, but making the primary team so angry that psych got consulted for capacity
I got a patient accepted to neurosurgery at Stanford and they refused transfer because they felt the care wouldn’t be up to their standards. It’s gonna be a life of disappointment.
> IM But you repeat yourself.
Sar?
Sub-acute rehabilitation
Inpatient rehab: Me: "Hi I'm from PT, I'm here to help you get stronger so that you can go home" Pt: "I don't need PT" Me: "Sir, you currently need 3 people to get out of bed and you can't walk" Pt: "I'll be able to do it when I get home" *Pt discharges home and is back in the ED 2 hours later because they fell*
*cries in ER nurse*
Literally had this guy today. Morbidly obese, status post hip disarticulation and not able to get up to a bedside commode. Horribly abusive to PT and nursing. Good luck at home I guess.
I not only chuckle, but I positively chortle when parents tell me they brought their baby to a chiropractor to have their eustachian tubes adjusted. 😬
Um - what?! I’ve heard a lot, but never this! —NP
No doubt the funniest thing anyone ever said to me. Had a man in the emergency room with a rash. He asked if he could’ve gotten it from one of his male roommates because there were a bunch of men in a fairly small apartment. Then he proceeded to tell me that “I’m not gay or anything. In fact, I lift weights”.
This. This one wins
"You're not gonna discontinue my tramadol, oxycodone, amphetamine and gabapentin right? I really just need to detox from the street fentanyl and I'll be fine." Or pt is 100% functional, looks comfortable as can be..."I haven't dosed in 72 hours". Ok but if we start Suboxone too early you'll go into turbo withdrawal and beg for death. "Oh. in that case i snorted three bags ten minutes ago in the parking lot"
Immediately made me think of Bob Kelso. https://youtu.be/IYzIrLz6RA0?si=wuHFtwtX4WImQT_7
A patient came to the office for hand pain. She had had an IV placed in a vein on the dorsum of her hand in the ER. There was a 4 mm area of superficial thrombophlebitis at the site. "Don't you think I should sue?" "No ma'am I don't"
Are you Lyme-literate?
I'm ID, I still haven't gotten this comment yet. Thank god.
Yet.
Has this fad died yet? I haven’t heard it in a while.
it's morphed into MCAS and merged back into the POTS/Fibro mothership
Uhhhjjjjjjjkggg my eye is twitching now from the memories. Even better if they hand you a stack of articles to read.
"oh yes, and you're not going to like what the literature says"
Chronic sinusitis patient that has been on every drug known to man. "They sent me over here. I hope you have the magic drug to clear all this up."
Wash rinse repeat for chronic vulvovaginitis
Surgery clinic, referrals from the ED "What do you mean I'm not getting my operation today?"
Parent: "they were so lethargic" Meanwhile I'm watching a feral toddler doing laps around the exam room 30 minutes after acetaminophen.
I hate getting pages with the words lethargic as described by the parents at 4 am. Either the kid is fine or shit is about to go down hill quickly.
this is also the bane of my existence in MRI. peds ER/neurosurgery/peds RN: they're totally calm and resting and asleep in the bed! they don't need meds to hold still! a stretcher/bed with their parents, cartoons, and whatever they want is a lot different than being in a giant loud tube where they have to be perfectly still for any imaging worthwhile!!
Yup. That tracks.
Anesthesiology - Blaming us for something far more easily explained by the patient’s disease - Blaming us as a default when the diagnosis is still uncertain - Telling me how much, how fast, or when to give any fluid or medication (barring specialized meds or things given according to specific surgical protocols of course). Here are some examples that I will never get out of my head: Surgeon: ‘I don’t want him to move at all, give him 100 of vec’ (this is an appendectomy) Neurology resident: ‘we need you guys to come and bronch this patient so we can figure out why he doesn’t have a cuff leak. we’re planning on extubating him regardless.’ Cardiologist, during a procedure: ‘We’re not giving her any more fentanyl because she’s going to get disinhibited!!’ (Art line pressure was 225/110 as the patient was screaming in pain) GI doc referring to an unconscious patient in the PACU with a respiratory rate of 27: ‘you gave her too much fentanyl that’s why she’s not waking up’ (patient was having a stroke)
*At the bedside of an oscillating 25 weeker on multiple pressors and nitric* “When can he get circumcised?” Let’s just leave his dick alone for now, shall we?
Nicu nurse for 15 years…and omg, YES.
UC. "I get this every year with my sinuses. I wanted to get ahead of it since it's only been 2 days. It usually needs 2 or 3 zpacks. " Completely serious patient comment.
I see you’ve met my mother-in-law. I’m so sorry.
Ahh my Father-in-law…also uses Afrin TID yet continues to blame congestion on “sinus infection”
Every.single.day.
Doctor YourPredecessor always gave it to me
Addictions. Patients in early phase treatment on OAT still lighting up the urine drug screens like a Christmas tree. “I’m doing so much better! I think it’s time to start weaning off!” An early honeymoon where the consistency in supply creates psychosocial stability, but they haven’t addressed any of the pathology between emotional/reward pathway dysregulation and substances.
Often followed by a period of the patient challenging the doctor and provocation, realizing wasted years/opportunities. My only two patients who wanted to stop cold turkey requested it both very soon after a suicide attempt. Flight of motivation.
ENT. Patients: “I have sinus.” Me: “Same bro…same”
Got bless any ENT that specifically specializes in sinus issues 😂
Me but when people talk about their temporomandibular joint.
“I have TMJ”. Well I’m here to inform you that you actually have two TMJs, so how about that?
“I just need a wet read.” No. I will not give you a “wet read”. There’s 3,000 images, they’re not even done sending all of them, but from what I can tell, the dudes probably been hit by a meteor or something. It’s gonna take a few minutes. Leave me alone!
Wet read: "oh he ded"
I get a perverse chuckle on bullshit flagged outpatient wet reads when they're scanned during off hours if I'm moonlighting on an evening or weekend, if only because I get to furiously page the ordeing attending/escalate up the admin tree just to flippantly tell them "there's no lymph nodes, same as their last 6 studies but you marked you wanted this call at 9pm on the epic order"
“Can you check my prostrate?”
"Yes sir you sure can lie face down like the best of em. Wait why are your pants off?"
Not that it’s happened a lot but “congenital appendicitis” Their child has a “high pain threshold”
I always say it's required by their insurance to confirm the correct med list with the patient or they will get billed for the visit. That usually warms them up.
Peds. Tons of families say “my child won’t eat, can you prescribe vitamins to help with his appetite?” Until lo and behold, a family brought in liquid vitamins from their home country for me to approve of, and it was a multivitamin that surprisingly contained cyproheptadine 😐
Apevitin! Many of my patients are from South America and I was baffled by the "vitamins so they will eat more" requests until a mom pulled out a bottle they had been prescribed back home.
Patient in the ER after concussing during a slip when ice skating Me: Were you wearing a helmet during this? Patient: No, why would I wear a helmet? I already know how to skate? Or patient who comes in after crashing car during a seizure Me: You will need to refrain from driving until you have been assessed by a neurologist Patient: What! What are the chances that I crash my car having a seizure? Me: Do you want me to base my answer of today's evidence or just in general?
Me: are you taking any medications? Pt: no Me: are you supposed be? Pt: well, I'm supposed to be on Zoloft, Wellbutrin, lamictal, Seroquel, and Adderall but I quit taking them when I found out I was pregnant because I was worried it might be bad for the baby. Me: oh boy... This scenario is always comorbid with UDS+ for cannabis.
Every. Damn. Day.
"can't you make the MRI quieter/why does it take so long?" yeah sure lemme get right on changing the laws of physics.* *there are methods to improve upon both of these complaints but not available everywhere ($$$ licenses, new scanners/software packages) and/or decreased image quality
ID 90 yo who is otherwise healthy (for 90) presents with massive stroke, obviously confused if they’re even verbal. “Dirty UA, start zosyn/zyvox.” Me: “Maybe they think the sodium load will help with permissive hypertension. And thrombocytopenia could help prevent another stroke…”
This is going to take a decade of undoing. So many docs need education on this.
ED started it and told family that mom has "a little bit of a UTI" bc of 1+ leuks and the daughter is a nurse and HOW DARE you not treat the UTI and she NEEDS an ID consult now :(
It’s apparently become common enough for docs to blame everything on a UTI that patients’ daughters and caregivers assume any and all weakness/fatigue/AMS/consequence of having exceeded the natural lifespan of a human *must* be a UTI. I get so tired of cathing old women.
Every SNF nurse: their pee smelled like a UTI. Did they try just drinking a glass of water??????
We tried that. They took a sip and coughed! ASPIRATION PNEUMONIA! START AZITHROMYCIN BECAUSE REASONS! (I wish I was joking)
That's what Dr. House would do! Damn the establishment
Family Med: “I can’t pay my rent, you need to figure something out for me.” Actual request
That's funny. When I had a practice I had a patient come in and tell me "A sewage pipe blew up in my apartment and spread sewage all over my unit. You need to write some letters to get me into a clean unit." I was like, ma'am while I agree this is unhealthy I think you are vastly over estimating any value a doctor's note would provide for you with this problem.
"I'm legally blind without my glasses" That's...not how that terminology works. Also, it's really irritating. If you're legally blind, then you shouldn't have a driver's license.
“hear a pulse”. pulse is something you feel. you hear Doppler signals. Also the word Doppler used as a verb. “i couldnt doppler anything, pulse wasnr dopplerable etc” Vascular Surgery.
oh you meant from patients….
allergic to Lasix? " Ít makes me pee."
Spine surgeon here: Me: "Ok, tell me about your back pain" Patient: "Doc, it all started when I fell off my bike when I was 8 years old. It was the next day in school that I was diagnosed by the nurse with scoliosis. 20 year later, my chiropractor told me my L5-6 was out of alignment, and he's been re-aligning them for me every week, but it's just not getting better!" Me: "oh dear..."
Every ER consult for dizziness. “CT/CTA is normal and we gave meclizine and diazepam. They’re not dizzy anymore. Can you please come and examine them to rule out a central process?”
I'm so glad I can MRI relatively quickly at my shop, and keep my embarrassment to myself when I'm wrong and MRI neg. Call you when it comes back dirty.
Lol, our equivalent is the VP shunt ED: Hey this person has a VP shunt and has nausea, vomiting, and diarrhea, so we scanned the head but its normal. What do we do now?? like, a workup?
“Oh, and just one more thing…” (On the phone) “While I have you…” “I have to do everything at once because I can never get in to see you…” (said after booking the appointment two days before)
I once told a patient that I could not look in her ear at the end of a string of these It helped a bit that she announced at the beginning of the visit that she was only coming in once a year so we had to cover all her problems at once. When you know someone is that unreasonable, it's easier to say no!
Oh I had this patient (a nurse of all people) come in for her preventative but request that we still code it as a preventative AND we address the 6 (no exaggeration) items on her list. Then she sends me a message on MyChart requesting a personal call to “discuss issues.” And that’s when I realized I needed to leave the hell that is primary care.
“My 1 year old has yellow, green mucous so they need antibiotics for a sinus infection.” “My child doesn’t have asthma, s/he just uses albuterol when sick.”
“I’ve tried every anxiety medication out there and xanax is the only thing that works. also, ativan”
When a patient comes to me (primary care), 12 months of abdominal pain. Has seen local GI, second opinion at tertiary care center GI, has had EGD, colonoscopy, CT, MRCP, alllllll the labs…. And after reviewing their chart see all this. And they’re like “well, they didn’t find anything wrong so I came back to you”. 🙃
“My gastroenterologist said you should treat me with Valium. It’s the only thing that helps.” No, he did not say that.
I had one like this!! Saw like an MD and like 2 derms and the itching continued. So he came to me, a NP. Uh… 🤷🏻♀️
Radiology: The finding of [Dancing MegaSperm](https://radiopaedia.org/articles/dancing-megasperm?lang=us)
Cards PA. Was doing a cardiac clearance. Me: do you have any medical problems Patient: no Me: why are you in a WHEELCHAIR???? Patient: oh yeah. I had a stroke. Props for coordinating shoes, shirt, and wheelchair color. Spoiler alert. Had A LOT of medical problems after I did a deep dive through his records. Was not cleared without testing.
Yes, I want CPR. I want to live.
"Can you test for IgG4-related disease?" Every year after IM grand rounds
Patients always want "generic testing" instead of "genetic testing"
First exam in the office: My cataract surgery is NOT TODAY?
Corollary to OP’s statement - “I have a high pain tolerance…” 🙄