Wednesday, March 24, 2010

Early Wednesday Rounds

I was at the hospital this morning, seeing a new stroke patient.

The head CT was read as normal yesterday afternoon, but when I looked at it I thought there was a stroke on the left side. And I didn't trust the person who'd read it, so I called the night radiologist (who I do trust).

Dr. Radar: "Night desk."

Dr. Grumpy: "Hey, it's Grumpy. I'm looking at the head CT on Mrs. Stroke. It was read yesterday as normal, but I think there's a stroke on the left."

Dr. Radar: "Hang on... No, that's not a stroke. If you look at the other images, it's just artifact."

Dr. Grumpy: "Are you sure? It really looks like a stroke to me."

Dr. Radar: "Positive. Definitely artifact."


I disagreed, but it's his specialty, and I respect him. I got off the phone and began writing my note. About a minute later a nurse came over to say Dr. Radar had called back looking for me.


Dr. Grumpy: "Grumpy."

Dr. Radar: "Yeah, it's Radar again. Did you say the thing on the right or the left?"

Dr. Grumpy: "Left".

Dr. Radar: "Sorry, I thought you said right. Oh yeah, that's definitely a stroke on the left."

19 comments:

Anonymous said...

MD left or patient left?

Grumpy, M.D. said...

Good point, but radiologists, and all doctors, are trained to refer to the patient's right or left.

terri c said...

Well, at least he fessed up. Maybe he hadn't had his Diet Coke.

JAB said...

You aren't helping my confidence in radiologists what so ever! A surgeon quoted to me recently that in his experience, radiology is wrong 1 out of 3 times. Hence he requires the patient to bring the films to him. Is that statistic accurate? Personally, the radiologists missed a fractured vertebra on two different occasions, caught only by the surgeon. I'm starting to wonder...

Kat's Kats said...

I refer you to my graphic, upper left, "Before Coffee" http://www.cafepress.com/KatsKats/6752844 It says it all. In fact, it was one of the first ones I ever made... for understandable reasons!!

Grumpy, M.D. said...

He's a damn good doc.

I think it was just a hazard of being a caffeine-deprived person on night call.

A bad doc wouldn't have called me back.

Helen said...

I didn't know doctors always referred to the patient's right or left.

Now I can stop wondering which one I should be referring to!

Grumpy, M.D. said...

Helen- on MRI and CT right and left are reversed. So convention is to always to refer to the patient's right or left.

Magnus said...

Yeah, hearing that he called you back does make me think he'd be a good doctor to have.

I've had a few really bad experiences with doctors who couldn't read the results of all kinds of tests, or forms with lists of meds the patients are allergic to, or whatever else. One guy instructed that a group home should give a woman ibuprofen on the same form as (and on the line directly under) a note that said she was allergic to Motrin. (I wouldn't have used a brand name, but I wasn't trusted to write the form out.) One resident claimed an elderly woman was drug-seeking and discharged her over my objections (and then objected to her using a wheelchair to get to the cab), only to have whoever reviewed his work call on Monday morning to insist that she come in right away for surgery on her broken hip. And so on. (And that's just doctors!)

Everybody makes mistakes. People who are aware that they sometimes make mistakes and do their best not only to not make them in the first place but to catch and fix them once they have made them are the ones you want handling important things. If I ever have a stroke, I hope it's one that many people can't see on the head CT. And I hope I have someone like Dr. Radar who double checks so that anything that needs to be found is actually found.

John Woolman said...

Matthew 5:30

Maha said...

Good catch Drs Grumpy and Radar!

Andrea said...

My clients will confuse their horse's left vs. right legs. "Well, Doc, it's the leg on the left if you're standing in front of him, but it's the one on the right when you're sitting on him looking down..."

Chris@Knucklehead! said...

That's a nice little "oh, by the way."

student dr. blaze said...

one of the funniest things you might ever see: 1st year med students taking their 1st anatomy exam. why funny? because everybody starts inadvertently pointing at themselves to remember what's R and what's L. ;-)

ERP said...

Kinda like "skier's right or left" - ie the right as you are skiing down the hill, NOT as you look up at it. Still, the main question I have is, did the patient obviously have a stroke clinically? If so, who cares about the CT if there is no blood on it? The MRI would confirm of refute the clinical findings.

Ladyk73 said...

What is an Artifact? a reflection type thing?

Grumpy, M.D. said...

LadyK73- just a false image, which can be from a number of things.

Outrider said...

Andrea:

My clients do the same thing ("it's his left leg when I'm facing him...").

Word verification = trout
Guess I should feed the cat.

msnovtue said...

Race workers do the same thing too-- it's driver's right/left.

And he did catch his mistake, and pretty quickly. Given this was night shift, I'd right this off to lack of sleep/caffeine. After all, I don't know how many early mornings in college I got up and poured myself a glass of milk and put orange juice on my cereal....

 
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