Kobayashi Maru

We are now in the third month of our government mandated electronic medical records system. It is amazing, not only does it require more staff, it also allows us to see half as many patients in twice as much time! On top of it all, patients complain that the computer is being takencare of instead of them. For the patients who are really lucky, it Eprescribes their prescriptions to one place so they cant shop around for a cheaper price. On a side note, we have just learned to break into the system so we can at least bypass some of the government mandated stuff to at least try to take care of some patients.

Butt sweat

Every now and then there is something that happens that no matter how hard you try to keep your composure, its all over. Today was one of those times. I was doing a history on an older patient who was being admitted. His family member was trying to recall all his medical problems when one of the things that was going on was "something that sounded like butt sweat". I couldnt figure it out until at last it made sense. The patient was having problems eating. Then I got it "AS-piration!"

Surgery cant cure phantom symptoms

Every now and then there is a patient that makes you just sit back and know that it is going to be a hard case. Not because it is technically difficult, but that the patient will be difficult. What I mean is, there are some who make up symptoms to be put into the hospital for the attention that it gets them. This is far more than the fibro patients. These patient complain of everything, but on careful questioning their symptoms wander all over and they cant quantify or localize any specific complaints. Unfortunately, sooner or later, someone will do a diagnostic study for one of the most rare conditions that exist. In the study, something incidental will show up. The patient then focuses on that and we are off to the races. Well, we had a patient like this show up in the ER. They were admitted and started their whole history. When the resident called me, the first thing I said was call every medical center in a four hour radius and get all her records and charts. Sure enough, the patient had been in every one and had every test known to medicine. At each hospital was a psyche consult that showed the patient was not right. This patient had years ago complained of vague abdominal pain. Unfortunately, someone went and did a laporoscopy. So every time she comes into the hospital, someone else decided that since nothing is showing up she needs another laporoscopy or open exploration to look for adhesions. As a result, we are off to the races. It is going to be a long call week.