Dr. Grumpy: "Next one, in room 734 is Mr. Spin, admitted for severe vertigo. I think it's peripheral, but ordered an MRI and..."
Dr. Nerve: "What kind of vertigo?"
Dr. Grumpy: "Positional vertigo. It happens when he turns his head left."
Dr. Nerve: "Which of the semicircular vestibular canals is involved?"
Dr. Grumpy: "Are you serious?"
Dr. Nerve: "Yes. Which canal is involved? Superior, Horizontal, or Posterior? They taught you that in residency, didn't they?'
Dr. Grumpy: "I have no fucking clue. I had 29 consults this weekend, and breaking that down isn't going to change my management."
Dr. Nerve: "I think these things are important."
Dr. Grumpy: "I don't when I'm swamped. On call my main question is whether it's central or peripheral. You want more than that, call an ENT."
Dr. Nerve: "Personally, I examine them closely until I've localized the canal."
Dr. Grumpy: "You do that. He's in 734. The MRI is pending. The next patient is..."
(Facepalm) Does it really matter which canal it is, as long as he's getting examined with an eye to treatment of the problem?
ReplyDeleteWould it be possible for someone to feel dizzy from brain damage, with nothing wrong with their inner ears? In that scenario, you're never going to locate the right canal because the problem's elsewhere.
Funny you posted this, Dr. G. I was having an "argument" with my colleagues along much the same lines today. About how some neonatologists seem obsessed with slotting all possible babies into "syndromes".
ReplyDeleteOK, I get that you need to identify the obvious ones in order to advise the parents to get genetic counselling. But when you scour all your NICU babies for tell-tale signs of obscure syndromes, then I label you borderline OCD.
I have more pressing matters in the NICU, FFS. Measuring the distance between nipples, or worse, the length of a perfectly decent looking baby-penis, is the last on my list before I head home a couple of hours after my official check-out time.
Some really anal doctors out there.
Oh, well... That's my grouse for the day, thank you for listening. Heh.
I was on vacation last week on the shore in South Carolina, as Hurricane Arthur approached, the Gov. of NC,said "Now is not the time to be putting on your stupid hats", apparently from reading last weeks entries, no one else got the memo as they were all wearing their respective "stupid hats" proudly I might add.
ReplyDeleteNamed Dr Nerve because he got on your last one...
ReplyDeleteNamed dr. Nerve because he had lots of it, being such an insufferable know-it-all ;-)
ReplyDeleteHmm, maybe if you identify an anterior canalithiasis then the canalith repositioning maneuver won't be as effective or even lead to worse outcome (per Adams & Victor's text)...
ReplyDeleteI'd be interested to learn what Dr. Nerve found on his exam to localize the specific canal, but I suspect I'll be waiting the same amount of time as I'll wait for that unnamed-NSAID pharm rep to send me the fucking references for the wild claims he makes while providing physician "education" ("I believe it was by the American College of Rheumatology" -- oh yeah, *that* study).
OMG! One of my friends had vestibular neuritis and it was easily found by the ENT this spring.
ReplyDeleteI had vertigo after a migraine, and I did this and took Benadryl and thankfully, it worked.(http://www.ucdenver.edu/about/newsroom/spotlight/patientcare/Pages/Do-it-yourself-Vertigo-Treatment.aspx)
Feel sorry for the patient (vertigo sucks) and for having an a$# for a consult.
Dizziness can occasionally be the only symptom of a TIA, or mini stroke.
ReplyDeleteSometime in late summer, or in the autumn, of 2012 (we are not sure of the exact date) my octogenarian mother had some vertigo attacks, while lying in bed. Later, a CT scan in the spring of 2013, revealed that she had had a slight stroke several months earlier.
I think I went to med school with Dr. Nerve.
ReplyDeleteJust kidding. But there's at least one of these in every med school class. Sitting in the front row, hand always up, and always ready to prolong a lecture with "interesting" questions.