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."

18 comments:

moppie said...

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

Grumpy, M.D. said...

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

Anonymous said...

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

Ninjamedic said...

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.

Jonathan said...

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!

Reality Rounds said...

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

davey jones said...

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

Anonymous said...

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.

HugeMD said...

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.

Grumpy, M.D. said...

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

Nurse K said...

Neuro consult too eh?

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

Lipstick said...

rule out meningitis??

LOL...oh my goodness...

Layla said...

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!

Grumpy, M.D. said...

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

DreamingTree said...

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.

Grumpy, M.D. said...

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.

thegooddrlaura said...

Did you send the hospitalist the link to this story?

Anonymous said...

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

 
Locations of visitors to this page