Wednesday, June 3, 2009

Gee, That's a Tough Case

Okay, fans, I had a neurology consult (granted, I don't get many other kinds) at the hospital this morning, on a 16 year old guy who began acting weird around 1:00 a.m. last night.

The following is, I swear, what the admitting hospitalist's note said:

"Impression: Patient who took LSD around midnight, and is now brought in for bizarre behavior and hallucinations. We will consult neurology to determine cause of altered mentation, check MRI, EEG, and labs. May need spinal tap to rule-out meningitis."
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21 comments:

  1. moppieJune 3, 2009 at 9:06 AM

    LOL, a painful spinal tap. That sure will teach the 16yo to use drugs in the future :)

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  2. Grumpy, M.D.June 3, 2009 at 9:09 AM

    Yeah, I thought about the spinal tap as a punitive measure, too.

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  3. AnonymousJune 3, 2009 at 9:15 AM

    you got it all wrong. the MRI, EEG and spinal tap are to work up dementia in the referring physician.

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  4. Ninja PharmerJune 3, 2009 at 9:54 AM

    Whiskey Tango Foxtrot, over?

    I read this to my 16 year old kid (Future Trauma Surgeon) and she said "well, duh!".

    I think that says it all.

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  5. JonathanJune 3, 2009 at 10:38 AM

    And people wonder why health care expenditures are out of control in this country. The internist may think twice if he had to pay for an inappropriate consult (and MRI) out of his own pocket!

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  6. Reality RoundsJune 3, 2009 at 10:58 AM

    Wow. And some hospitalists complain about nurses not having critical thinking skills: http://thehappyhospitalist.blogspot.com/2009/03/what-happened-to-nursing-profession.html
    Nice

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  7. davey jonesJune 3, 2009 at 11:45 AM

    is this to do with being business minded, or retarded? When healthcare is free, this is a nightly occurence.

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  8. AnonymousJune 3, 2009 at 12:45 PM

    Wow, when he has to go into the MRI and that thing starts whirring and clicking, he's going to lose his mind. Play some happy music. In fact, that's probably the best treatment option.

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  9. ShrinkingDocJune 3, 2009 at 2:39 PM

    I'm amazed over and over by the lack of common sense by people who one otherwise might consider intelligent.

    I think we should ditch the MCAT and figure out a test that screens for common sense instead.

    It sounds like this maybe should have been a PSYCH admit, not a medical one in the first place.

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  10. Grumpy, M.D.June 3, 2009 at 2:49 PM

    The number of docs out there who are "book smart, and patient dumb" is remarkable. And somewhat frightening.

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  11. Nurse KJune 3, 2009 at 7:05 PM

    Neuro consult too eh?

    Impression: Dood's trippin'. Recommendation: Avoid the brown acid.

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  12. LipstickJune 4, 2009 at 12:47 AM

    rule out meningitis??

    LOL...oh my goodness...

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  13. LaylaJune 4, 2009 at 5:11 AM

    Oh dear, how very worrying (but unfortunately not that surprising). This doc obviously didn't get out much during med school.

    Re the MRI scanner freaking the patient out - when I did Neurology as a junior doc, I had a frankly psychotic guy (turned out to have ADEM) whom we tried to put through an MRI scanner - he (unsurprisingly) wouldn't lie still. The (male) radiographer came on over the intercom saying, 'Stephen, please lie still, calm down...' etc). Stephen stopped thrashing about and lay very still. 'Is that God??!' he asked. The radiographer came back over the intercom. 'Yes Stephen, this is God. And I want you to lie very still for me.'

    Worked a treat!

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  14. Grumpy, M.D.June 4, 2009 at 7:37 AM

    Layla, that is GREAT! I'll have to keep that trick in mind.

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  15. DreamingTreeJune 4, 2009 at 9:22 AM

    Great story, Layla! I tend to go with the flow with dementia pts & the crazy things they see. Plenty of spiders, bombs, & pencils (disguised as heplocks) -- never get the fun hallucinations.

    Grumpy - that hospitalist could have been our Dr. Snippy. She has book knowledge, but application is a very real problem. Consequently, they put her on nights - she could never manage to stay on track for days.

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  16. Grumpy, M.D.June 4, 2009 at 9:24 AM

    That's so reassuring. So when something goes bad at night Dr. Snippy is the only one there, with no back-up.

    These people are smart, but better suited to careers in research or insurance review.

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  17. thegooddrlauraJune 9, 2009 at 1:09 PM

    Did you send the hospitalist the link to this story?

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  18. AnonymousSeptember 9, 2009 at 12:53 AM

    Dr's note:
    The latter treatment is not needed unless the patient goes to 11.

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  19. friendly neighborhood lab techJuly 12, 2014 at 12:04 AM

    I'm going back and reading your archive so I'm tardy to the party. The first comment reminds me of an ER doc I work with. I honestly think he has started to do blood gasses on any patient that comes in frequently with nothing wrong with them. "Oh you're short of breath while you are having a conversation with me with ease and your finger O2 sensor says 98? Let's jab you in the artery with a needle just to check"

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  20. ayeekazDecember 31, 2018 at 4:11 PM

    We do a workup on every patient that comes in high to the cost of a couple grand. It's so much fun.

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  21. AnonymousOctober 29, 2022 at 6:39 AM

    Our options are A) anxious new grad. B) mid-to-late career private practice hospitalist who shot gun consults the entire hospital to do the work up while he/she goes to clinic, C) surgeon, or D) APP

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So wadda you think?