Sunday, May 17, 2009

Pretend Doctors

This has been a long call week so I am pretty fried. Several of the emergencies that I was called to see where the result of pretend doctors for which it seems we are seeing more and more. The first was a patient with mylodysplastic syndrome that makes what little platelets he has not work well. When he went to get his pain medication filled he was told by the pharmacist that he could also take aspirin or ibuprofen to help with the pain. Of course, this made the few platelets he had not work and came in bleeding. When I asked the patient why he took the aspirin, even though he had been told not to, he said "the pharmacist was a doctor! "

The very next patient came into the ER with severe back and shoulder pain. He had been seeing his independent nurse practicioner for a large swelling on his shoulder that did not get better with the multiple courses of antibiotics. The back pain had been getting worse for months. Our xrays showed that shoulder mass was a metastatic tumor as was the tumor that had eroded the body of his T6 vertebrea causing his severe back pain. Turns out he had been having hemoptysis a few months ago and the same NP treated it with antibiotics for his cough. His lung cancer is unresectable. We tried to get medical records from the NPs clinic. They do not answer the phone on the weekends or have an answering service.

The last case was the one that really broke me. A really nice gentleman who came in to the ER with generalized weakness and headaches. He was really proud that he had never had any medical problems and he attributed it all to his holistic lifestyle. In fact he goes and sees his holistic physician once a month. They had been trying all different types of therapy but he was getting weaker and weaker and ended up in the ER when he fell. His EKG showed AFIB, his ejection fraction on echo was about 20% and his lungs were full of emboli from atrial clots. His histrory was a bit hard to get as he had to breathe with the rebreather.

I know that there are good nurse practicioners, good pharmacists and good holistic practicioners out there. I also know that there are bad doctors out there. What I think makes the ones that are good, good is that they know that something is out of their league and they get help. Hopefully, they get help for their patients before its too late.


SeaSpray said...

Hi Throckmorton-hopefully now that your call week is finished, this week will be much better. :)

It's a shame about the patients you saw and sad that these things happen.

And I agree with you.. they should know their limits.

SeaSpray said...
This comment has been removed by the author.
SeaSpray said...

I'll add one to your list.


Patients who try to diagnose themselves,potentially wasting valuable time.

I was thinking about this post as I was lying in bed this morning and realized I am doing that right now. Your post unnerved me a bit as I lay there thinking about those patients. It seems time was wasted and was of the essence for prevention or correction but they passed the point of no return.

I would tell someone else that they should err on the side of caution and get checked and that their doctors would rather have a false alarm... then have to deal with a serious, possibly irreversible issue in the future.

At one time I was hypervigilant and now have gone in opposite direction and just vent in blog.
So I have this wait and see approach.

Thanks for the thought provoking post! :)