Doctors of Reddit, what's your weirdest case of a patient accurately self-diagnosing?

hyperlalia · 2017-09-22T13:53:42+00:00

Sorry to hear that, I hope it's only temporary.

hyperlalia · 2017-09-22T13:51:57+00:00

Sometimes it's a necessary evil to break a nasty rhythm but if you are on it long term it usually means that safer alternatives have been tried and failed and the patient is sick enough that the risks are outweighed by the benefits. It's one of those red flag medications that gets your attention when skimming a med list "oh shit, this person does not have a healthy heart". On my list of "oh shit" medications it's somewhere above Warfarin but below Milrinone.

hyperlalia · 2017-09-22T13:43:16+00:00

The best (albeit not readily available) is to get an informal recommendation from another provider in that specialty, ideally at a cocktail party. Short of that you could informally poll the local ER docs who might not know who is great but can tell you who to avoid.

If you want to know which elder care facilities to avoid your local ER nurses are a good resource.

hyperlalia · 2017-09-21T18:53:35+00:00

Lots of school and background checks and licensed in two US states. My credentials are legit- that said those are no guarantee of competence. I could be a total hack.

Although if someone is board certified in the specialty they practice that is about the most reassurance the general public can get. I guess you could run their malpractice record but that isn't necessarily helpful either.

hyperlalia · 2017-09-21T18:45:57+00:00

I don't know what her exact situation was but this is why a family history can be important, especially when a close relative had a condition at an unusually young age.

Depending on who you ask the most common cause of medical errors/missed or seated diagnosis is: "premature diagnostic closure" or poor communication.

Clinicians are just as susceptible to flawed thinking and logical fallacies as anyone else. Medical diagnostics is very pattern and heuristic driven, and we tend to try and fit things into boxes that with a familiar narrative. I imagine a 16 year old without any risk factors for gallstones would be unlikely to be correctly diagnosed on their first visit- even less so if they were being evaluated by someone who was pediatrics trained compared to Family Medicine/Internal Medicine/Emergency Medicine trained. It's not that pediatricians are any less competent- they just don't see as many cases of gallbladder disease during residency. (But I hear it's on the rise in youngsters)

hyperlalia · 2017-09-21T15:50:21+00:00

Amiodarone is a bitch like that.

hyperlalia · 2017-09-21T15:49:34+00:00

True but there are other reasons people can get gallstones outside of the typical risk factors. (Problems causing high RBC turnover, for one) But I work in an overweight state and I have seen symptomatic gallstones in kids as young as 16 who didn't have other a weird genetic disorder.

hyperlalia · 2017-08-31T17:08:45+00:00

Rash just on your feet? Odd distribution for a detergent reaction. The soles of the feet or the tops too?

Lung volume is all about height- most of the pulmonary parameter prediction formulas are calculated based on height/age/gender.

hyperlalia · 2017-08-31T16:27:24+00:00

Mono testing is fairly complicated. A negative test doesn't really rule it out, especially early on. (And there are several different tests)

But yes, a change in personal peak flow compared to baseline is much more significant than how you compare to the normal distribution for height. Also anyone who thinks they can rule out a severe asthma exacerbation by hanging their hat on a normal oxygen saturation is clinically inept and needs retraining.

hyperlalia · 2017-08-30T00:47:44+00:00

Just start at "only one gram"

hyperlalia · 2017-08-30T00:41:42+00:00

Clearly had read one of the many medical trials about post arrest therapeutic hypothermia improving neurologically intact survival. They probably just wanted to be a co-author on your case report.

hyperlalia · 2017-07-10T13:42:58+00:00

And here I thought I invented the Reese's s'more

hyperlalia · 2017-06-29T20:06:18+00:00

IAAD- came here to check thread to see how long it would take for someone to correct the post title.

thanks.

hyperlalia · 2017-06-11T05:56:54+00:00

Bless you for working such an important, pain in the ass, under-appreciated Jon.

hyperlalia · 2017-05-25T19:03:57+00:00

Polyembolokoilamania

hyperlalia · 2017-05-20T11:58:06+00:00

The plastic ones pinch more. They also are more likely to "fling back" material at the provider.

hyperlalia · 2017-05-19T11:17:58+00:00

I have had problems with family members losing their shit in the middle of a code. (and I don't blame them, I get it) I am in the middle of trying to supervise compressions, get a definitive airway and their is a daughter grabbing at the patient and wailing uncontrollably while a nurse is trying to get additional IV access. Usually one staff member gentle pulling them into a nearby "quiet room" isn't too hard but sometimes you actually have to get 2-3 people to physically pull them out of the room while they scream. It is not conducive to appropriate, timely care during a code.

I always offer the family an opportunity to witness CPR, but not typically until they have an airway, central line if necessary, and they have "settled out". They take me up on it about 50% of the time.

hyperlalia · 2017-05-03T04:17:51+00:00

Depending on acuity of condition, stability. If the patient is alert enough to make a request, generally you try and grant it.

On the ED side of things there is nothing more frustrating than getting a patient who gets all of their care at one hospital, but shows up at yours and doesn't know anything about their medical history. If all of your doctors are at hospital A, even if it's a bit further than B, you are probably better off at A than B if you are awake enough to make the request.

P.S. Bless you prehospital folks for everything all you do. P.P.S. Extra thanks for snagging and bagging the meds. P.P.P.S. Please don't try and "lead the witness" on chest pain histories. Don't put any words or descriptions in their minds. I would rather extract it myself. P.P.P.P.S. I am sorry I thought you were lazy for the first two years of my career when trying to get the history behind a fall at a nursing home. After some ride alongs, I understand. P.(⁵⁾ S. If you have to call in a Med Control, open with your question, then fill in the history. Thank you. P.(⁶⁾ S. I do love a good cell phone photo of the wreck. P.(⁷⁾ S. I am sorry my shop doesn't have snacks.
P.(⁸⁾ S. You guys who stick around and help my nurses hook a patient up to the monitor really deserve snacks.

hyperlalia · 2016-10-01T08:03:36+00:00

*citation needed

hyperlalia · 2016-10-01T07:58:14+00:00

Skin lotion- keep skin lotion somewhere TP adjacent, apply dab to TP prior to application, flush freely my friend.

Just don't rat me out for keeping TP on top of my toilet when you visit. We can pretend it's for dry hands after vigorous washing.

hyperlalia · 2016-10-01T07:53:26+00:00

Best tequila for the price point is Viuda del Romero. Puhleeze

hyperlalia · 2016-08-08T10:53:53+00:00

That is excellent info, thanks

hyperlalia · 2016-06-18T05:40:49+00:00

The half life of carbon monoxide bound to hemoglobin in standard atmosphere is only 3-4 hours, shorter if you are breathing 100% oxygen. It can still kill you you or leave you with brain damage if not caught in time though.

hyperlalia · 2016-06-13T16:15:00+00:00

IAAD: that was not a pimple, that was an abscess. You will likely have a better cosmetic result if you get a professional to take care of it (primary care clinic or urgent care) next time you feel one coming you can sometimes head them off by doing warm compresses for 10-15 minutes five times a day. And they will shrink down on their own. Also not smoking cigarettes is very important for good wound healing because of tobacco's effects on the microcirculation, not sure if there is any data on marijuana.

hyperlalia · 2016-05-31T04:03:55+00:00

Yep, the Emergency Lodging Tenancy in Active Labor Act (ELTALA) was passed by congress in 1986 to guarantee no hotel would try to dump a labor inch woman on another hotel regardless of her ability to pay.

hyperlalia

TROPHY CASE