Timing; Following Up
Many thanks to all who responded to my conundrum about conveying bad news on a Friday. Lots of different answers confirmed my initial impression: there really wasn’t any “right” answer. I just did my best based on what I know about my patients. Just thought I’d let y’all know how it played out.
Monday came.
I picked up the phone the moment I got into the office (pretty FSM-damned early) and caught the patient before leaving for work. Conveyed the fact that I had news and that it wasn’t good. Arranged for patient (and spouse) to come for an appointment within the hour.
They reacted about ...
Source: Musings of a Dinosaur - October 1, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Timing
The history was concerning. The exam was alarming. Labs were sent; imaging ordered; possible diagnoses, including dire ones, were discussed at length. A hug was offered and accepted, and the patient left with assurances that I would call just as soon as I knew anything.
The next day the radiologist called, which is never good. It wasn’t. Then the labs popped into my inbox. All the information was back. It was time to call the patient.
But I didn’t.
Why not?
It was late Friday afternoon, and I made the conscious decision to not make the call right then.
Here’s how I looked at it: either the patient got to...
Source: Musings of a Dinosaur - September 20, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Hypochondriasis (Part 2)
Even paranoids have enemies [citation needed]* and even hypochondriacs get sick.
I have a patient who is a full blown hypochondriac sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: the other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop after actual HIV infection.) He once believed his kitchen counters were radioactive because of a news report...
Source: Musings of a Dinosaur - September 11, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Hypochondriasis (Part 1)
HYPOCHONDRIAC: a person who is abnormally anxious about his or her health.
“Am I a hypochondriac?”
It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health.
No, the fact that all you have is a simple upper respiratory infection — the common cold — instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and I have no problem providing all the reassurance you need. Whether it’s explaining why your ...
Source: Musings of a Dinosaur - September 10, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Why Isn’t it Better?
Doc, my shoulder is killing me. I can’t sleep, I can’t work; you’ve got to help me.
I saw you in the office two weeks ago for this, right?
Yeah, that’s right.
Did you get the x-ray I asked you to get?
No.
Did you try the heating pad we talked about?
No.
How about the over-the-counter pain relievers I mentioned.
No.
[Deep breath]
How can I help you.
I think I need a MRI.
[Another deep breath]
They won’t let you get an MRI without an x-ray [see Third Law]
But why isn’t it better?
[Pause for several deep breaths]
Why indeed. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - September 9, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Those to Whom the Rules Do Not Apply (In Their Opinion)
There’s a patient I don’t like very much. I’ll call her Mrs. X.
Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.
Every time she makes an appointment, she calls and changes it three, four, five times. After all that, she often doesn’t show up.
The first time I saw her, I identified several health issues. I told her that her blood pressure was too high, as was her cholesterol.
Her response:...
Source: Musings of a Dinosaur - September 1, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Breakfast
Puffy Pancake:
Hazardous mainly to the waistline. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - August 24, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Food Source Type: blogs
Muscle Memory
Muscle memory is a marvelous mechanism. Now that I’ve gotten that alliteration out of my system, let me explain.
The piano pictured above is a family heirloom Bluthner grand piano built in 1909. We know this because we found the serial number inside, then looked it up on the Bluthner age table. It was brought over from Europe by my mother’s family in the late 1930s. My uncle had it for a number of years, then my parents took it when he died. I’ve had it since about 1985. When we recently downsized, we made sure there would be a dedicated space for it — and what a space it is! Suffice to say the p...
Source: Musings of a Dinosaur - August 17, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Source Type: blogs
Marble Dinosaur Egg: “What’s Your Concern?”
Another in a continuing series of the Dinosaur version of “clinical pearls”. Okay, so the series consists of three other posts, all in 2007:
Medication adherence
Biliary symptoms
Extending your scale
But hey. Here’s another.
One of the most important things we teach medical students is to elicit any specific concerns patients may have about their conditions. Many of them get pretty good at it, though by the time they get through the rest of their training, perilously few of them — now that they’re called “attendings” — are still doing it. Yet I maintain it’s still one...
Source: Musings of a Dinosaur - August 4, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Good Guys and Guns
Just in case there’s anyone left who hasn’t heard, there was a shooting in a hospital last Friday. A mentally ill patient brought his legally-owned gun into his psychiatrist’s office, where he proceeded to shoot and kill his case worker. He then pointed the gun at the doctor, who ducked behind a chair, drew his own legally-owned, concealed-carry pistol, and proceeded to shoot the patient in the arm and torso, disabling him and preventing him from utilizing the rest of his ammo (approximately 40 bullets total).
Official comment was swift and relatively unanimous:
Yeadon Police Chief Donald Molineux said t...
Source: Musings of a Dinosaur - July 30, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Politics Source Type: blogs
Personae Public and Private
The house is done; we’re all moved in, mostly unpacked, and just starting to get organized. The guest room is my temporary writing room. No more excuses. Back to blogging.
My post analogizing car seats to vaccines has taken on second life thanks to a cool Australian site (Thanks, Mamamia of Oz.) This in turn has generated more comments (thanks, all!) including a long, thoughtful one from Patrick, who begins thusly:
I honestly believe there is fault on both sides of this debate. Vilifying and ridiculing each other doesn’t bring about good health results.
I feel the need to clarify something here:
I am not the same i...
Source: Musings of a Dinosaur - July 22, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Built a House (27): Final
It’s done. We’re all moved in. So is our stuff; well, most of it. The piano arrives in a few more days. Then all we have to do is unpack, hang art, paint; you know, make it ours.
Once that’s all accomplished — or at least once I’ve cleared away a spot to sit down with a computer — real blogging will return. For all of you who followed along (three or four, I think) thanks so much for hanging in there with me.
(Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - July 13, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Source Type: blogs
Not Just Tacky…
Wandering around Lowes picking up stuff for the new house, I came across this:
How tacky is this? Not just tacky. It’s….
…Wait for it…
Tiki tacky. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - June 29, 2014 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Funnies Source Type: blogs
