true story kiddos!

TSK: She just came in for “eye infection”

Cranquis: So did anything happen to your eye before it turned red and itchy?

40-something female patient: NO IT’S NOT INJURED, IT’S JUST INFECTED.

Cranquis: Ok. Have you been around anyone with pink eye lately?

Patient: NO BUT WHEN I WOKE UP YESTERDAY MY CAT WAS LICKING MY EYE.

Cranquis glances at the chart – ‘ALLERGY: Cats’

Patient: SO I KNEW MY CAT WAS GOING TO INFECT MY EYE, AND I TOOK SOME OF MY BOYFRIEND’S ANTIBIOTIC PILLS BUT THOSE WEREN’T STRONG ENOUGH BECAUSE THE INFECTION IS SPREADING, LOOK! 

Patient lifts shirt to reveal hives on torso

Cranquis glances at the chart – ‘ALLERGY: Bactrim’

Cranquis: Were the antibiotics called Bactrim?

Patient: HOW DID YOU KNOW THAT?

TSK: Go with the flow

30-something female patient with sinus infection: …”and then my ears started hurting and I got dizzy, I feel drunk and I haven’t even started drinking for St. Patrick’s Day yet!”

Cranquis: Well that sucks!

Patient: I KNOW! And the worst is, I started my period while I was in your waiting room, so… HAPPY ST. PADDY’S DAY TO ME.

Cranquis: Happy St. MAXI Paddy’s Day to you.

Both:

TSK: I’m not even joking, I checked and this is exactly what happened.

Cranquis: So your daughter has been vomiting?

Mom of toddler: YES, SHE VOMITED AT BREAKFAST!

Cranquis: Has she been able to eat or drink anything since then?

Mom: WELL SHE VOMITED BECAUSE SHE TRIED TO EAT HER BROTHER’S ENTIRE HARD BOILED EGG WITHOUT SWALLOWING BUT AFTER IT CAME BACK UP SHE CHEWED IT IN PIECES AND THAT STAYED DOWN JUST FINE.

Cranquis: 

Thanks for calling to check up on her, doc – and one more thing. Thanks for examining her stuffed animal during the visit yesterday. She keeps telling everyone, ‘The doctor checked out Winnie the Pooh and said he doesn’t have an ear infection, but I have an ear infection.’
— 

Mother of a 3 year old kid with doctor-phobia – which eased up nicely after I gave poor long-suffering Winnie a full physical.

(It’s so awesome when that works…)

TSK: The Derminator

Anxious teen with forehead laceration: ARE YOU GOING TO USE A NEEDLE TO NUMB IT UP?

Cranquis: What do you want me to say? (places drape over kid’s eyes)

Teen: I HATE NEEDLES

Cranquis: “I hate needles” (prepares to inject)

Teen: (laughs)

Cranquis: Or as Ah-nuld Schwarz-neggah would say, “GAHHHH AY ATE NEEEDOSE GET TO DA CHOPPAH!” (injecting the entire time)

Teen: (laughs more) WELL JUST TELL ME WHEN YOU’RE GOING TO START INJECTING

Cranquis: “OHH NAOW, IT’S TOO LAYYYT, I ALRADY FEENESH DAT!” yeah that part’s already done, so you’re all numb now.

Teen: ok that was awesome.

You’re the first doctor to actually touch me in 17 years. The rest of them just see a fat guy and write a prescription.
— 

480-pound man with intertrigo.

WTF, my colleagues? Just because a person weighs more than another person doesn’t mean that you get some kind of Physical Exam Not Required modifier. Since when does “patient is obese” = “patient’s self-description of their medical concern is enough for me, wouldn’t want to actually use my skills to make a proper diagnosis”?!

This rage isn’t just targeted at “the rest of them” – I’m upset when I recall the times that I’ve convinced myself that a physical exam of an obese [or smelly or wheel-chair-bound or hyperactive or or or] patient isn’t worth the hassle. Sure, some of those times it probably wasn’t necessary in order to manage the presenting complaint – but what unknown overlooked conditions did I miss by being lazy, by stereotyping my patient and offering 2nd-class medicine? SMH.

So let’s make this our guiding slogan when faced with internal pulling-back from providing the usual standard of care, my colleagues:

“Patients: Gotta Touch ‘Em All.”

TSK: What chew doin’?

Ok, fine, you came to see a medical doctor about your broken tooth. I understand that. As a non-dentist, I’m not thrilled – but in today’s healthcare environment, I do understand.

But is it too much to ask for you to spit out your wad of chewing tobacco before my (thankfully-gloved) fingers find it while sloshing around in your brown-flecked mouth?

TSK: Now remember, children -- Motrin and Ibuprofen are the same drug.

Cranquis: So what meds have you tried for your knee pain?

50-something Patient w/ knee arthritis: MOTRIN.

Cranquis: How many pills and how often?

Patient: ONE. JUST ONE.

Cranquis: Well I can tell you that 1 dose of 200mg of Motrin is nowhere near enough anti-inflammatory to make a difference in an adult patient.

Patient: EXACTLY. SO PRESCRIBE ME SOMETHING STRONGER.

Cranquis: Well, I could, but the prescription meds have greater side effects; why don’t you try taking a higher dose of Motrin for a few days? Or switching to Aleve?

Patient: NO I WANT A PRESCRIPTION, I’M NOT WASTING TIME ON THOSE PUNY DRUGS.

Cranquis *wishing Pt had used a Schwarzenegger accent just then*: Ok then, I’ll prescribe you Diclofenac, but it could be harder on your stom–

Patient: HOW MANY MG IS THAT?

Cranquis: 75.

Patient: DON’T TRY TO BE SNEAKY WITH ME DOC, YOU JUST SAID 200MG WASN’T ENOUGH AND NOW YOU WANT TO GIVE ME ONLY 75MG!

Cranquis: No, see, it’s a different drug, and th–

Patient: I NEED A STRONGER MEDICATION, SO GIVE ME SOMETHING WITH A BIGGER MG!

Cranquis *a pause*: …Oh, I know! How about a short-term prescription for ibuprofen, 800mg tablets?

Patient: NOW THAT IS MORE LIKE IT. GEEZ.

Cranquis

TSK: Hiccups x 1 year

Saw a 10 year old kid today. Young fella has seen multiple doctors for “hiccups” (Urgent Care, Pediatrician, ER), has been prescribed antacids and antihistamines, has been referred to GI (no appointment for another 4 months) Mom and dad are frustrated: “It’s NOT hiccups, we keep trying to explain, his tummy muscles jerk and a sound come out of his mouth and his jaw flops opened and closed, but it’s just NOT hiccups.”

And I agreed with them. The kid (rather obviously) has a motor/vocal tic disorder, possibly Tourette’s (if the workup through neurology and psychiatry doesn’t turn up any organic causes for his tics). But if I had agreed with the previous doctors’ notes, agreed in my head before entering the exam room, I would have interpreted his mannerisms and vocalizations as a (kinda-weird  and uncoordinated) hiccup.

Today, in my Urgent Care, the best thing I could do for this boy was to avoid automatically jumping to the same diagnosis everyone else has made. The only thing he and his parents needed (for now) was for someone to observe, keep the differential broad, ask questions from a different angle, think outside of the “box” created by his previous doctor visits.

I didn’t write him a prescription, I didn’t scope him or lab him or admit him. I just looked and listened and thought and recognized and recommended. And his mom left my Urgent Care so happy to have a name for it and a plan to pursue.


They left, and I started writing up his note with a trace of smug satisfaction… and I got the hiccups.

TSK: My future colleague

Cranquis (finishing throat exam): You can leave the facemask off, unless you want to keep wearing it.

5-year-old female: I want to wear it.

Cranquis: Yeah, some kids like to pretend they’re a ninja with it.

Patient: Or a doctor!

Cranquis: Hmm, good point. So which is cooler, a doctor or a ninja?

Patient: A doctor.

Cranquis: Right answer! You are going to get SO many stickers today…

Naw, I’m scared to use those inhalers. I had a buddy who used those for years, and he died.
— 

50-something male with a COPD exacerbation and influenza… still smoking 2 packs/day… but really worried that Symbicort will kill him.

(He doesn’t get the flu shot either – it has all sorts of chemicals in it.)