At the free health clinic:
Doctor: Patient came in the other day with anal pruritis (itchiness). What is it?
Student: Well the only thing I can think of is from pediatrics and it's Enterobius infection.
Doctor: Okay, well if you wanted to test that theory what would you do.
Student: Scotch tape test. Would you do that here in the clinic?
Doctor: No. We don't have any scotch tape here.
Sunday, March 16, 2014
Saturday, March 15, 2014
Difficult patients
I was working with a doctor who was obviously quite jaded and angry, but rightfully so. I have become more jaded working in the hospital just from the people we have to deal with every day. It's one thing that they aren't compliant and have no desire to help themselves, but it's another thing entirely to then blame the doctors for trying to help them. Nevermind the fact that just trying to illicit a decent history or explain something to them is impossible. Also, being in a spanish heavy area is difficult. Most of them get upset that you don't speak spanish. This particular doctor had no problem saying exactly what was on his mind. I still felt uncomfortable standing next to him as he said it.
Patient: My back hurts so much.
Doctor: I sent you to ortho. They wrote here that you refused physical therapy in the hospital.
Patient: No. They said to me that I had to go to this other hospital for shots in my back and I don't know where that hospital is and they don't take my free health care there.
Doctor: I'm reading the note right now from the ortho doctor. It says that you refused to go to the physical therapy right here in the hospital.
Patient: No I did not.
Doctor: Okay. Fine. We will just assume ortho is lying then. You will go to physical therapy?
Patient: Yeah, ok. What did my MRI show? My back hurts so much.
Doctor: It showed some minor arthritis in your spine that I would expect any 70 year old to have.
Patient: But it hurts so bad! You don't know what this pain is like!
After the doctor told me that he gets upset when patients tell him he doesn't know what the pain is like. Who are they do assume he hasn't felt pain?
(Through a spanish translator)
Patient: I need a referral for ophthalmology.
Doctor: I gave you a referral last time you were here, you made an appointment, and you didn't show up.
Patient: No no no. I called and called and called and they never picked up the phone.
Doctor: That isn't the issue. What I'm telling you is that you had an appointment and you didn't go to it.
Patient: No. I called and called and called. Finally someone picked up the phone and I tried to speak a little english, but they didn't speak spanish and that is not my problem.
Doctor: First of all, you didn't need to call anyone. All you needed to do was show up to your appointment and you did not do that. Second of all, them not speaking spanish and you not speaking english is not their problem, it is your problem. How long have you been in this country?
Patient: 20 years
Doctor: Twenty years?! And you haven't learned any english?? Where are you from?
Patient: Peru
Doctor: If I went to Peru, I would learn Spanish.
These conversations are not unique. The way this particular doctor dealt with it is, but a lot of patients feel entitled. It's difficult not to be hostile when you are being attacked or getting false information or being lied to. Doctors are only human also.
Patient: My back hurts so much.
Doctor: I sent you to ortho. They wrote here that you refused physical therapy in the hospital.
Patient: No. They said to me that I had to go to this other hospital for shots in my back and I don't know where that hospital is and they don't take my free health care there.
Doctor: I'm reading the note right now from the ortho doctor. It says that you refused to go to the physical therapy right here in the hospital.
Patient: No I did not.
Doctor: Okay. Fine. We will just assume ortho is lying then. You will go to physical therapy?
Patient: Yeah, ok. What did my MRI show? My back hurts so much.
Doctor: It showed some minor arthritis in your spine that I would expect any 70 year old to have.
Patient: But it hurts so bad! You don't know what this pain is like!
After the doctor told me that he gets upset when patients tell him he doesn't know what the pain is like. Who are they do assume he hasn't felt pain?
(Through a spanish translator)
Patient: I need a referral for ophthalmology.
Doctor: I gave you a referral last time you were here, you made an appointment, and you didn't show up.
Patient: No no no. I called and called and called and they never picked up the phone.
Doctor: That isn't the issue. What I'm telling you is that you had an appointment and you didn't go to it.
Patient: No. I called and called and called. Finally someone picked up the phone and I tried to speak a little english, but they didn't speak spanish and that is not my problem.
Doctor: First of all, you didn't need to call anyone. All you needed to do was show up to your appointment and you did not do that. Second of all, them not speaking spanish and you not speaking english is not their problem, it is your problem. How long have you been in this country?
Patient: 20 years
Doctor: Twenty years?! And you haven't learned any english?? Where are you from?
Patient: Peru
Doctor: If I went to Peru, I would learn Spanish.
These conversations are not unique. The way this particular doctor dealt with it is, but a lot of patients feel entitled. It's difficult not to be hostile when you are being attacked or getting false information or being lied to. Doctors are only human also.
Friday
Chief resident: Ok residents, now that we have just presented the case, any idea what this is?
(Silence)
Chief resident: Anyone? Any ideas at all?
(Silence)
Chief resident: Is this some sort of revolt against me?
(Silence)
Resident: What was the summary again?
(Silence)
Chief resident: Anyone? Any ideas at all?
(Silence)
Chief resident: Is this some sort of revolt against me?
(Silence)
Resident: What was the summary again?
Saturday, March 8, 2014
Gonna have to be more descriptive than that
Daughter: She is having pain in the front and the back.
Me: Can she point with one finger where the pain is on her front?
(Daughter and mother exchange looks)
Daughter: She went to the ladies' room and it hurt her.
Me: Ah, so she is having pain when she goes to the bathroom?
Daughter: Yes. In both the front and the back.
Me: Ok, so when did she start having pain with urination?
Daughter: Oh dear! We don't use that kind of language!
Me: Can she point with one finger where the pain is on her front?
(Daughter and mother exchange looks)
Daughter: She went to the ladies' room and it hurt her.
Me: Ah, so she is having pain when she goes to the bathroom?
Daughter: Yes. In both the front and the back.
Me: Ok, so when did she start having pain with urination?
Daughter: Oh dear! We don't use that kind of language!
Psychogenic polydipsia
Me: So what brings you in to the emergency department today?
Patient: I drank a lot of water. I have been vomiting all day. I feel so sick.
Me: When did you start vomiting?
Patient: After I drank a lot of water.
Me: Uhh, ok how much water?
Patient: Like a gallon and a half.
Me: And why did you drink this much water? Do you feel really thirsty?
Patient: No I felt sick to my stomach and wanted to throw up.
Me: You made yourself drink water to throw up?
Patient: Yes
Me: Why did you feel sick to your stomach?
Patient: Because I drank a lot of water!
Patient: I drank a lot of water. I have been vomiting all day. I feel so sick.
Me: When did you start vomiting?
Patient: After I drank a lot of water.
Me: Uhh, ok how much water?
Patient: Like a gallon and a half.
Me: And why did you drink this much water? Do you feel really thirsty?
Patient: No I felt sick to my stomach and wanted to throw up.
Me: You made yourself drink water to throw up?
Patient: Yes
Me: Why did you feel sick to your stomach?
Patient: Because I drank a lot of water!
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