Woes from the clinic - Dr's side

[MDLackey]

Hi everyone, long time lurker, first time poster.

Little background: I'm a med school graduate currently working as an assistant at a multi-specialty office. I'm also working towards getting my license, sort of a MD beta version, not yet full release with a few bugs in it.

As much as I love helping out patients with genuine medical issues, some just has some WTF non-medical issues that just blows my mind. Time to share:

WTF # 1
25 year old guy comes in wanting to get a referral to see a GYN.

Problem 1: You dont need a referral to see a GYN, so therefore that kinda defeats the purpose of his visit.

Problem 2: Why is a 25 year old guy, unless he happens to be a human transformer, wanting to see a doctor specializing in women's health?

Answer: Apparently he wants to ask a FEMALE Doctor about FEMALE questions. Turns out, he had sex with a girl at another country back in September, and in January was told that she is now 10 weeks pregnant. So he wants to find out if that is his child so he can decide if he needs to break up with his current gf/wife or not.

I weep for humanity.

WTF # 2
49 year old lady come in for follow up on her blood work. She freaks out after I told her that her Cholesterol levels is 7 points over the recommended limit. She is asking me how to bring it back down and what to do about keep it down, but will not accept my advice to keep a low cholesterol and low fat diet,or the fact that as a person ages, the metabolism slows down and will slowly see these levels raise anyways. Not to mention a person's condition is dynamic and always changing.

WTF # 3
70 year old lady come in to see "Boss" (Boss is a GI specialist), complaining that she was "vomiting blood" this morning. Since Boss was at the moment seeing someone else, I figure I see to her first and get things rolling. Before she even sits down, she asks: Are you "Boss"? My natural response: No, I'm his assistant, he will be along shortly. Since your complaint sound quite serious, I wanted to see to you first, so that when "Boss" comes in, we can move along quicker to get you treatment. Sounds reasonable right? Apparently not to her. She flips out, starts screaming how she's been waiting an half-hour to see a doctor, and that she vomited blood, BLOOOODDDDD!!!! She then reaches into her bag, pulls out a plastic bag and THREW it on to the desk in front of me. The bag held a plastic container, within was half filled with red fluid. SERIOUSLY!?!?! Did you just threw a container of "blood" at me. Good thing it was close shut, if that had burst open, it would've been a different matter. Good thing Boss showed up right at that moment and told me to go outside and he'll deal with her.

Honestly, I get it you are concerned that you vomited "blood" or something like it, since the fluid in the container was too watery to seem like blood. But did you have to freak out and throw it at the person that's trying to help you??

[blas]

I've said it before and will say it again, I don't know how you guys do it. I realize there are plenty of bad docs and nurses out there, but boy, for the amount of sucky people there are, that ratio is more sucky patients I believe.

Some of the stories I hear about and read on here (esp the ER ones) just make me want to bang my head against the wall.

[fireheart]

WTF # 1
25 year old guy comes in wanting to get a referral to see a GYN.

Problem 1: You dont need a referral to see a GYN, so therefore that kinda defeats the purpose of his visit.

Problem 2: Why is a 25 year old guy, unless he happens to be a human transformer, wanting to see a doctor specializing in women's health?

Answer: Apparently he wants to ask a FEMALE Doctor about FEMALE questions. Turns out, he had sex with a girl at another country back in September, and in January was told that she is now 10 weeks pregnant. So he wants to find out if that is his child so he can decide if he needs to break up with his current gf/wife or not.

I weep for humanity.

Yeah that wouldn't have been his child. Not unless 10 weeks means 4-5 months somewhere else....sounds like a full-on idiot to me who's looking for an excuse to break up with his girlfriend/wife. Although I'm guessing the infidelity would've been enough anyway.

On the other hand, he may have wanted a recommended GYN. My local GP practice CAN refer people on, but three of the doctors on site (2 female, 1 male) are also capable of acting as OB/GYNs when needed. (there are 2 nurses, plus a pathology lab next door, who can handle most of the services)

[Rapscallion]

Answer: Apparently he wants to ask a FEMALE Doctor about FEMALE questions. Turns out, he had sex with a girl at another country back in September, and in January was told that she is now 10 weeks pregnant. So he wants to find out if that is his child so he can decide if he needs to break up with his current gf/wife or not.

Um, maybe he ought to go back to school and learn how to subtract? *facepalm*

Welcome aboard!

Rapscallion

[Bright_Star]

Jeez, who vomits blood into a bag to take to a doctor later??

[trailerparkmedic]

#3 Kinda reminds me of a drunk chick we had to transport for "vomiting blood". The "blood" was the dozen red jello shooters she had just done coming back up. That was a fun one.

I spent a night in the ER with my husband because he vomited red popsicles that he hadn't bothered to tell me he'd bought or eaten. He didn't remember them until after we'd gotten to the ER, he'd been brought back, they'd drawn blood, and they were doing diagnostics.

The only good thing was that I was frantically trying to finish a care plan (weekly paperwork due each week in nursing school) that was due the next morning and the nurse took pity on me and gave me some answers.

But, yeah, please don't bring "proof" of whatever complaint to the hospital. I have to see enough nastiness as it is.

[MDLackey]

My thanks to Rapscallion for the welcome.

This board has given me many glimpses into many types of people I may encounter, and in turn, has prepared me to be not be surprised when I encounter them, but still, some does take the cake.

Like I mentioned, I feel thrilled whenever I can help out someone with actual medical issues. But the many of the non-medical issues that I do see on a daily basis just tests my tolerance and drains my energy.

[Seshat]

Correct me if I'm wrong, but doesn't blood go blackish in stomach acids anyway?

[Sapphire Silk]

Hi everyone, long time lurker, first time poster.

to ! We have cookies, booze, chocolate, and bacon to console any need.

WTF # 1
25 year old guy comes in wanting to get a referral to see a GYN.

Answer: Apparently he wants to ask a FEMALE Doctor about FEMALE questions. Turns out, he had sex with a girl at another country back in September, and in January was told that she is now 10 weeks pregnant. So he wants to find out if that is his child so he can decide if he needs to break up with his current gf/wife or not.

I weep for humanity.

So do I. He has several problems.

1. He can't do basic math. There's no way he could be the father, unless his you know what is a long as the Trans Atlantic Cable.

2. Even if the math did work, she's on another continent. Did it ever occur to him she might have slept with other guys in the right general time frame? Or does he really think he rocked her world so well she's been celibate every since, and only gave up her virginity for him?

3. Even if it is his kid, how is breaking up with his current squeeze going to do any one any good? Without a marriage certificate, ICE is not going to let the girlfriend into the country. Does he think he's going to become an ex pat? Yeah. Right.

WTF # 2
49 year old lady come in for follow up on her blood work. She freaks out after I told her that her Cholesterol levels is 7 points over the recommended limit. She is asking me how to bring it back down and what to do about keep it down, but will not accept my advice to keep a low cholesterol and low fat diet,or the fact that as a person ages, the metabolism slows down and will slowly see these levels raise anyways. Not to mention a person's condition is dynamic and always changing.

She wants a magic pill to make the problem go away. Change her diet? Pleeeeaase.

WTF # 3
Honestly, I get it you are concerned that you vomited "blood" or something like it, since the fluid in the container was too watery to seem like blood. But did you have to freak out and throw it at the person that's trying to help you??

One of the first lessons I learned about hematemesis is what looks like blood may not be blood. If it's red and thin, check to make sure the patient hasn't been eating red jello, popsicles, cranberry juice, or any other red colored food. Ditto for stool.

Always check for occult blood.

I had a little talk with my husband (Ranger medic at the time) that yes, letting me know that due to the years of dipping a bit of blood in his vomit is normal. If he hadn't been so sick I would have whomped him.

Uh . . . blood in vomit is never normal. If he's been using dip, and has blood in his vomit, he's at risk for esophageal cancer.

Correct me if I'm wrong, but doesn't blood go blackish in stomach acids anyway?

Yes. It often takes on the appearance of "coffee grounds." However, people can vomit up bright red blood as well. It can be a sign of a number of things, including esophageal varices (enlarged blood vessels in the esophagus), and a bleeding ulcer.

[MDLackey]

Hahah..Thanks Panacea..I have heard great things about the cookies.

With regards to the first guy, we have yet to heard the end of it, but it wont bode well for him regardless. It's his life to ruin. I swear, the new slogan for abstinence should be "Safe sex, Save money!! For mere dollars for a box of condoms, you can save thousands in child support!"

Cholesterol lady, I dunno what her deal is. She was even challenging my Boss when trying to go over her blood work. Asking everything and anything she can think of about every little detail in the blood work. But she only had 3 things that showed up as abnormal in the blood work, and the only thing that was medically relevant was a 107 for her LDL.

And as for vomit blood lady, I never found out what happened to her, nor did i see her again. But I doubt it was blood in plastic container. It was too bright red and too watery. Plus if she had the strength to be yelling at me, she's not sick at all.

Bonus WTF: Had a lady called our office threatening to sue for malpractice. Her mom was sent to the hospital for abdominal pain, the nurse there drew her blood and found elevated levels of white blood cells and Liver function enzymes. The mom previously had blood work done in our office as part of her annual physical. So the daughter is claiming negligence on our end for not reporting any abnormalities in mom's blood work. The kicker: I looked at the blood work done in the office, EVERYTHING was NORMAL. Not even the slightest doubt at all. Guess someone wont be winning the lottery this time.

[MDLackey]

Hey 24601, did your husband ever had imaging tests done? X-rays? CT scans? If not, best to get 1 done just in case.

We had a patient that was coughing up blood (about half a Styrofoam cup) every few months for 5-6 years. He was also checked every time with no major findings. Finally did a CT and found a mass in his lung, and needed surgery. I had yet to see him since the surgery, but i hear he's doing well, tho gonna have slightly decreased lung capacity for the rest of his life. Better safe than sorry tho.

[fireheart]

"Safe sex, Save money!! For mere dollars for a box of condoms, you can save thousands in child support!"

I think I love you.

Fingers crossed my cholesterol level isn't off the charts

[NateTheChops]

Heck, before it got refurbished I always loved the way this one store I worked at had it's condoms located on the same wall as the diapers. I'm sure it wasn't intentional but what a way to get the message across.

[Sparky]

Aaaand I can't let this conversation go any further without refering to this:
http://www.youtube.com/watch?v=nojWJ6-XmeQ

[MDLackey]

That's an awesome vid Sparky. They so need to play that on TV, bars, doctor offices, hospitals, hell...blast that 24/7 in Times Square.