Thursday, April 29, 2010

To Annoying Internal Medicine Attending circa 1993

Flea Attending: I want you all to know that in my, blah de blah, hmmmm (coughs up hairball), excuse me; In my thirty years of practicing MEDICINE (spittle flies from mouth) that I have never met a "poor historian"... (wait for it like SMITH-BARNEY!), but I HAVE MET... I HAVE MET MANY POOR HISTORY TAKERS.

Most medical students around him.... "Wow, he's SOOoooooooo dreamy."

Me and Eto' and 'Cat... "Wow, what an idiot... Hey, are you guys going to see Dash-Rip-Rock tonight? Yeah? Sweet! Drinks all around. Is this guy still talking?

First shift back in ER a few days ago...

Me: Ma'am, how may I help you tonight?

Patient: I don't even know, I don't want to be here... the only reason I'm here is my son and he forced me to come.

Me: Well, ma'am, I'm sure there's something that is concerning him, are you feeling well?

Patient: Hell no! I'm sicker than a dog!

Me: And what are your symptoms?

Patient: Well every year about this time I get allergies and every year before this one I took one benadryl and it went away. But this year I've been taking all kinds of benadryl and this morning I like to fell out when I tried to stand up.

Me: Can you tell me what it felt like when you "like to fell out"? Did you actually pass out?

Patient: Hell yes I passed out!

Me: You went completely unconscious, woke up on the floor, and didn't remember the fall?

Patient: Hell no! I liked to pass out, my head just wasn't right and it got swimmy and my legs went noodle-y.

Me: So you became dizzy and weak in the legs?

Patient: Hell no! I got swimmy-headed and my legs got noodle-y.

Me (gathering testicles in hand for reassurance): Let me ask you about the benadryl... how much have you been taking?

Patient: None... well, one.... I mean all kinds of it, for weeks, and it's not helping.

Me: I see, is there any chance you took anything besides benadryl?

Patient: Hell no! Don't you listen? The only thing I took besides benadryl was benadryl plus, a red pill, and my sons blood pressure medicine, and I cut it into fours and took one because my blood pressure was really high.

Me: Do you happen to remember the name of the blood pressure medicine?

Patient: (wait for it) ... The blue one.

Me: Ma'am I'm very concerned about your symptoms and I'd like to run some tests. If, after my testing, I think you should be admitted to the hospital, will you stay?

Patient: Hell no! Just fix me up, I'm going home.

So, in summary, annoying Flea attending from medical school. Fuck you... you never even talked to a patient. Thus endeth the rant.

Good Day


  1. Oh, if you had just asked this one a few more "open-ended questions" that would definitely have helped. You know, just like they taught us in second year. Ugh. This is why we all cringe when the chief complaint is "dizziness", don't you think? The conversation often goes like that in my humble opinion.

  2. dear HugeMD,

    just so you know, in Spanish, "dizzy" is "mariada"... as for taking the rest of the history in Spanish with open ended questions i just can't face it.

  3. So that's why guys grab their nuts? For reassurance? I did not know that! I thought it was just like playing with your keychain or something.

  4. I did an IMed residency before EMed residency. I heard that mantra about poor history takers over and over. Never heard it from a doc who actually TALKED to patients though. Only from the IMed attendings in residency. Anybody who talks to patients knows that it's BS.

    Peggy, we're just checking to be sure that the Gov't hasn't imposed a 50% "ball tax" in the middle of the night and taken off with one of 'em. With Barney Frank as Chairman of the House Financial Services Cmte, you have to watch these things!!

  5. roger the ball tax.

    at least the surgeons could be funny with their platitudes... "the only reason not to do a rectal exam is if you don't have fingers or the patient doesn't have a butthole."

    but they are wrong too.

  6. OMG, dizzy in Spanish would be horrible. For those of us not fluent enough, with an interpreter, it's really bad. OK, try this one--hearing-impaired guy, really nice, dizzy, but more like, "something's just weird inside my head", and "my ex-girlfriend smoked in my house and could it be this and that". It went on for what seemed like days and probably was hours.

  7. dear HugeMD,

    easy ER answer... walks, talks, wiggles fingers... neuro normal... outpatient CT scan and refer to neuro or psyche. okay, never mind... refer him to someone who might do something for him... allergy... ent... aromatherapist... wiccan healer.

  8. Hell yes. Dash Rip Rock. Oh to be a drunk college kid again.

    Obvious case of Benadryl Hangover and "adverse reaction to medication" by taking her son's BP pills. Easy fix. Stop both, generic fluticasone nasal spray for allergies, d/c home, and no need to admit and cost tax payers money.

    Now, what time is DRR playing and what's the cover?

  9. Thanks 9-11, for stoking my Unabomber-like hatred of pompous Internal Medicine Attendings...
    and everyone blames Plague on the poor bacteria, or the rats, when its the effin FLEAS that actually spread it...
    But did you ever piss on one of there Graves?? I mean really did it, not just dreamed of it?
    Neither did I, effin A-holes burried in California, and the last time I went there was a damn funeral 10 feet away, wouldn't have stopped me, but didn't seem right to urinate in public with 1/2 of the LAPD watching...
    How bout.....
    OK, occasionally thats true, but its not really profound.
    What really used to chap my ball-sack was how the IM attendings complained about "Taking Call" which they did from home, while all the other attendings had to actually be in the hospital.
    Umm except for the Shrinks and Pediatricians, but they don't really count...
    Used to stick my dogs old flea collars in one prick Medicine Residents Starched-Whiter-than-a-Mormon-Temple-in-Idaho-all buttons buttoned Lab Coat-Pocket...
    Dumbass never figured out who did it, talk about your poor diagnosticians...

    Frank "I hate Fleas" Drackman

  10. anon.,
    she got zebra-ed and handed off to night guy. she was 84 so i'm sure she got admitted after her husband and sons and daughters browbeat her into it. sent an aspirin level on a hunch. o/w spending thousands on her made me no smarter.

    see post on nitrous oxide. i haven't really wanted to piss on anyone's grave yet. i have a feeling there will be a line at mine.

  11. anon. part 2,

    i do not know where Dash is playing next but the link to their site should list a variety of dives all around the world where you might go and see them and get riotously drunk while dancing till you sweat through three shirts. good times.

  12. i haven't really wanted to piss on anyone's grave yet. i have a feeling there will be a line at mine.

    Ok then. What sorts of flowers tolerate piss well?

  13. Calla Lillies, Wax Begonias, Narcissus, & Foxglove will all enjoy standard urine.

    If you plan to use premium nursing home pee, then Queen Anne's Lace, Box Elder, Japanese Barberry, & Hackberry are better options.

  14. It figures that two flowers I particularly dislike (callas and begonias) enjoy urine.

    I have pretty much beaten into my family's heads the importance of giving an accurate history and carrying a medicine list in their wallet. I'm only half-joking when I tell my husband that if he ever goes out to a bar, I am going to write his medical conditions and medications on his chest with a permanent marker. (It would have saved me a lot of research and concern if I had known that low potassium is hereditary in his family.)

  15. Here's a good one:

    Patient: "My ear hurts."

    Doctor: "Which one?"

    Patient: "I don't know."

  16. dear PeggyU,

    aw shucks *sniff*

    dear oddharmonic,

    you have confused me with your logic and sense of responsibility. may neither you nor your husband ever need my services.

  17. OH: I have had trauma patients transferred to me with the original scene EMS notes written on their torso with a Sharpee! I thought it was effective. It contained only the pertinent info and I didn't have to waste time searching through all of the mandated BS on the EMS forms to find the info that I needed.

    Your post reminded me of many years ago when my Dad had open heart surgery. The surgeon was Argentinian. This was during the Falkland/Malvinas Island "War". He was heavily sedated pre-op and we wrote "Malvinas Forever!" on his chest.

    Little did we know at the time that the scrub nurses would simply obliterate it before the surgeon saw it. Good times!

  18. Was she anticholinergic from benadryl toxicity?

  19. dear serenitynow,

    good question. vitals didn't go with it, neither did she... i know she sounds crazy in the post, but she long ago embraced it and then punched down on the pedal and taught it a thing or two.