Mrs. Myelin: "This is Sarah Myelin! My MS made my left arm go numb yesterday! I need to see Dr. Grumpy, and get an MRI done, today!"
Mary: "Well, it's Friday afternoon, and we don't have anything till next week, let me... Wait, you sent us a letter last month saying you were transferring care to Dr. Oligodendro down at Humungous Neurology, Inc."
Mrs. Myelin: "Yes, he's my neurologist now. I saw him yesterday for this."
Mary: "Okay, so why are you calling us?"
Mrs. Myelin: "Because Dr. Oligodendro's staff couldn't get an MRI scheduled on me until tomorrow, and I want it today!"
Mary: "But if he's your neurologist now, you'll have to work with his office, not ours, for this."
Mrs. Myelin: "Look! I'm willing to go to ANY doctor who can get me an MRI today! If you can get me in today, and get an MRI today, then I'll come back to you!"
Mary: "Ma'am, this isn't a contest."
Mrs. Myelin: "Nobody cares about patients anymore. I'll just go to ER and get them to do it."
17 comments:
You know, I really find some of your posts about patients entertaining. But in this case, I feel I can understand Mrs Myelin freaking out and wanting an MRI.
And now I know why we have a patient who called 911 to be transported to the ER for an MRI on Friday night...
-Wu
Oligodendro--love it!!
MS sucks... I almost had this same freak out last month so I feel for her. :(
.......and an MRI done today instead of tomorrow in a patient with known MS will change the treatment how, exactly? MS sucks, and I get the fear. But I don't understand what she thought the MRI was going to change
Well...if its a stroke and not the MS she would want clot busting which is time sensitive. Agree that if its not Dr Grumpy's patient its not his problem.
Fear on pt. part, rules (and common sense) on MDs part.
Never a fun combination. The other way around would be much worse, though. ;-)
MS does suck. And to Anon 8:59, geting an MRI done isn't going to change anything, but it MIGHT (I said might) affect treatment.
MS pts learn fast that sitting around and doing nothing often makes things worse. And with a disease like MS, one that is capricious and strips control away, getting a quick DX may help. It gives back a sense of control.
If her previous fiance hadn't had to work on the opening night of "Harry Potter and the Chamber of Secrets," she probably would have stayed with him and not married me instead.
Since when does a patient decide that an MRI is needed at all, let alone on an urgent basis? If she has symptoms of a stroke, then she needs to go to the ER, where it will be determined what she needs.
...but she had had symptoms for >24 hours, well outside tPa and MERCI criteria. Also appears that her new neuro didn't tell her to go to the ED for r/o CVA. I get the fear, but education by her new neurologist would have been great. Of course, then we wouldn't have had this entertaininig post. :)
While I have empathy for the pt AND Mary, we've all gotten calls like this. A more extreme case: the pt had a vaccination scheduled in two weeks but demanded it TONIGHT.
I agree that some patient teaching was missed when she contacted her neurologist's office and before she called Dr. Grumpy's office. But, then again, it is (of course) nearly impossible to provide teaching to a panicked patient who is convinced that they are going through something dangerous. What happened to her was extremely scary. I wonder if Dr. Oligodendro had a similar experience with her when she called his office.
Trully, MS does suck.
Get MRI, start IV solumedrol a little bit faster, but I might head to an ED anyway as it could have been a stroke.
Dr. G. I am a TOTAL luddite but REALLY want to start a blog.... entitled along the lines of....
how do I loathe thee neurologists, let me count the ways. Have such excellent material, right up there with your patient stories. Can't tell you how many patients I've met who went to neuros who could not even diagnose MS. AAACK.
If the patient had already been seen by her neurologist for the current complaint, then the neurologist had probably ruled out a stroke, or other disorder with time-sensitive treatement.
I can't go along with "TOTAL luddite." I'm a patient with a couple of neurologists. Diagnosis and treatment of neuropathies is difficult, because there is a lot of variation. I think some patients expect too much of doctors generally, not merely neurologists. I'm impressed by how much they do know about what's going on in the human body, not what they don't know.
This kind of thing happens at the pharmacy all the time. A customer decides to switch pharmacies for whatever reason, then comes back to my store with a prescription for some expensive, obscure medication. When I explain that I have to order it, they freak out. It's even worse when it was an item we kept on hand just for them, and I just tossed the bottle into the expired meds box.
Agree with Anon who discussed why the MS patient didn't go to the ER to rule out CVA.
Have an MS patient who did indeed have a CVA (family hx). Just makes you wonder what might have happened...sad.
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