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When your doctor asks you 'what happened' PLEASE tell the WHOLE story..
Before my first clinical rotations started, my professor stated that patients will reveal their diagnosis in their history, 80% of the time. That’s why being able to ask the right questions, getting detailed answers is SO important.
I cannot even begin to stress how many diseases have similar clinical presentations, but vary only slightly in some symptoms. When a patient, sees a physician, we only have a certain amount of time with them, meaning we do not get to observe ALL of the symptoms that occurred at first, yesterday, last night, two hours ago…. we only see what is presented before us.
So when a patient is able to comply and doesn’t skip details because of embarrassment, shyness, etc…. it REALLY makes a difference.
My little rant stems from my ER shift last night.
Patient, young, obese female, chief complaint: decrease of depth perception, color visualization, and fuzzy light vision.
Patients history, version 1 (summarized):
Eyes burn. Daily decrease in depth perception, and seeing lights. Normal light spectrum is shortened to a fuzzy blob. Colors are no longer clear, anything blue or black now seems like a light grey. Already went to THREE ophthalmologists, who stated that everything is fine, and no significant changes can be seen. Changes are in both eyes. IT MUST BE A BRAIN TUMOR.
After asking some questions, we found out.
The patient has had worsening symptoms over the past week, however had been suffering from vertigo, and headaches for a few months now.
By this time it was already 11 pm (my last patient), the neurologist had done her examination and concluded that either it was nothing, or it could have been a hormonal change.
Patient was going to get a head CT and be admitted to the hospital for further observation………
Now, as I’m walking out of the hospital I notice this patient is following me, so I ask if she’s planning on leaving because she’s going to be admitted.. to which she said..
‘You’re young and you seem like someone I can talk to, and you’re going to be an amazing doctor and I hope that one day you run this department. (AWWWWW :) MADE ME FEEL GOOD) But I don’t understand why they won’t run some EEG’s or other tests on me. I’ve had CT scans done already, and the light and vision is really bothering me…’ (clearly getting distressed now)
Ma’am, do you have your results from previous CT with you? (no.) That is why we need to run our own tests, gather the results to see what can be the cause of all of this. CT scanning will give us a better image and idea of what can be going on, rather than an EEG which would show us your brain waves and activity..
BEST PART RIGHT HERE.
BUT I’M JUST TIRED, AND I WANT AN ANSWER, BECAUSE I’M PREGNANT I WOULD RATHER BE HOME THAN AT A HOSPITAL.
WHY DID YOU NOT MENTION YOU WERE PREGNANT DURING YOUR TRIAGE, OR HISTORY, OR ANYTHING WHILST TALKING TO US OR THE NEUROLOGIST….
‘Oh, is that important?’
…. I have no words ……