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my-most-extreme-patient-encounters

My Most Extreme Patient Encounters

I'm coming up on 10 years of being a practicing doctor and I've had some incredible patient encounters while this patient encounters weird patient encounters so I thought I'd share a few of them right now let's get started be whoop this story um still haunts me to this day that it happened in the way that it did because it really shouldn't have went down this way and this happened actually when I was a student I was rotating at this medical facility and I walk into the room I'm like what's going on you guys are pretty banged up and they said well we were involved in a car accident coming back from Florida the husband was behind the wheel of the car and actually fell asleep and ended up crashing the car at a very high rate of speed they said well we think we're okay and we kind of went to the local hospital where we crashed they were somewhere down south but we felt like they didn't do a full evaluation that we thought was satisfactory so we came here and I see that the male patient has a fractured clavicle the female patient has a broken humerus and so much so that I think it damaged her nerve plexus because she has a wrist drop there was significant injury that was visualized on all of these tests there were hip x-rays abdominal CAT scans but the one thing that wasn't there which shocked me was a head CAT scan so I go back into the the precepting room which is where you talk to all the senior doctors and I said look let me dig into this case I really looked through all the scans I looked at all the records the intake forms and I see that the female patient is on Plavix that's a blood thinning medication she's on a blood thinning medication just got into an accident at a high rate of speed and did not get a CAT scan this is definitely wrong I present the case to my attending my attending as a family medicine doctor firmly agrees says I cannot believe is outraged that we're absolutely got to get them to the ear the next day I come into work and I'm so curious to see what has happened I'll open the medical record to see what happened with this case and I see that those patients left against medical advice meaning that they signed a form saying that I don't want to be here that I'm leaving before the doctor has cleared me to leave the ER doctor said that the family medicine doctor doesn't know what they're talking about you're fine now it's been over 24 hours since your car accident because you're not showing any symptoms there's no use to getting a CAT scan and that you're going to be fine and I'm like look this is going to sound really annoying but I think you should go back to the ER they're like well look can we talk to your senior physician I'm like he's not here today but as soon I'm telling you you really should go to the ER because you're on blood thinners your husband wasn't in great shape either I really think both of you need to get scanned and because I have another attending physician that's here right now in the hospital we can meet you and get you scanned even if the ER doctor this time says no the female patient has actually been admitted into the neuro ICU because it turned out turned out that after getting the CAT scan she was actually having a very slow bleed into her brain as a result of being on the anticoagulation medicine Plavix and it had to do an emergency craniotomy which is with them opening up the skull and relieving the pressure and had they not done that she could have died and probably would have died to be honest I was like oh my god did I just save a life because of all this the craniotomy went well the neuroicu stay went well everyone ended up recovering all this stuff had a very happy ending but because this was what we classify as a near-miss we actually had to file reports with our system in the computer where we report these near misses we met with the head of the emergency department to talk about why this happened and created policies to make sure this never happens again I was working in my clinic late one evening and what I like to do before I start my hours is actually look through who's on my schedule look through what's going on in their medical history to make sure I'm not missing anything when I walk into the room and I saw on my schedule at the end of the day was a young patient a young girl that was coming in uh for like a sore throat so I didn't think anything of it when I look later in the day that patient switched to a different patient a male patient with a very similar name when I walked into the room I right away got a little bit of a strange sense that something else was going on because the patient was acting a little bit reserved so I said let's let's investigate I introduced myself I started asking the questions and the patient abruptly abruptly shifts the conversation and says doctor I have to admit the real reason I'm here I'm aware that your mom has passed and I'm like thinking where is this possibly gonna go well I'm here because I actually have a message from her to you and I think it's really important that I share it and at this moment I'm really confused because I don't know what to do I want to be professional at the same time I know that this patient is being unprofessional and I don't know exactly what my next steps should do so I kind of gathered myself and I said I appreciate you doing that but I am here working and I have to take care of patients who are having illness and need my help while I'm appreciative of the message I'm not interested and I have to move on to the next patient I hope that's okay with you and to my surprise the patient was that's perfectly fine I'm okay with you doing that but I just want to say that I needed to get that off my chest and share that with you totally through me but we moved on and we kept taking care of other patients I actually have a patient who I've been taking care of for many years who happens to be a doctor and we start talking about their health they tell me that everything is in normal working order they don't smoke they drink socially very rare drug use they are sexually active intermittent protection this is a male patient by the way look at the lab work and I see that it's all it's all looking good and then something happens which I really wasn't prepared for I see that the HIV fourth generation test flag positive first of all it's fairly accurate there's not many instances where this test is inaccurate and they had a very big reaction tears and I understood why tears were coming they were very worried they didn't know what was going on they weren't sure if this was a sexual exposure or if this is a patient exposure would I talk to them I said okay look this is a test that needs to reflex to other tests and it's likely that those tests are still pending so let's wait for those tests to come back which then allows us to understand what um type of virus this is and again we're talking about human human immunodeficiency virus which if untreated can progress to AIDS they obviously were very emotional about I said look go home I should have the results by the day I'll call you at the end of my work shift I see that the rest of the tests are all negative I in my history of being a doctor have never really seen a false positive for this fourth generation HIV test in this instance I said before I call the patient back I probably should do some really thorough research to give them answers why this was a false positive so I pull up up to date which is one of our most used resources as family medicine doctors which we use as a reference tool and the the thing tells me that the HIV fourth generation test which has changed since my education which was third generation Test Now can flag false positive in some very specific instances one is pregnancy two if they are taking HIV medications three is if they have an autoimmune disorder and then cave number four if they've recently received a flu vaccination apparently and this is something that I even learned in that moment there is evidence that when a patient receives a flu vaccine that they actually develop some antibodies that react with this agent on the fourth generation HIV test which can make it come up positive but then if you check the rest of the test they will all come up negative and knowing that this patient of mine is a health care provider knowing that I can look into the record and see when they've had their flu shot five weeks before they had their flu shot and there we go we had my answer so I called the patient back told the patient good news they obviously requested to be retested just to make sure we rechecked in a few weeks and everything was totally negative at that time but that's why it's really important that when you're ordering tests you know what to do if it's positive negative or even if you don't know what to do you know where to look to get those answers so uh the other day I had a patient who's around 40 50 years old and they say doctor like I've finally been able to lose around 25 pounds we've been talking about them losing weight for some time they finally lost the 25 pounds and I haven't seen them in quite a bit of time so I was sharing in their celebration I was like great job so happy for you how did you lose the 25 pounds the patient said you know what I just haven't been doing anything I just happened to lose 25 pounds and I was like wait wait you've lost 25 pounds without trying like unintentionally and they said yeah how long of a period of time did this happen and he goes it's been about a month five weeks maybe now all these alarm bells are going on in my head and I started asking about other symptoms well you know I've been a little bit tired a little stressed out with work but the fact that I'm losing weight makes me happy the patient also mentions some night sweats I also looked at the patient during the physical exam The Tint of their skin color was a little bit off than their usual because I've seen them for three years I felt like it looked a little bit more pale I need to order some tests to give me reassurance that you're not really sick the patient has a slight abnormality in their complete blood count and it was like so mild that maybe some doctors look at it and say no big deal I didn't like the whole story I felt like there was something more so I I told the patient that I was feeling this way and I said look I think we should get a scan and rule out that there's nothing else going on something more Sinister like cancer what does the insurance company do denies the scan we send in my paperwork they deny my paperwork so now I have to get a prior authorization I called the insurance company on hold talk to one person another person and I finally get a peer-to-peer which is I'm talking to someone who's also a medical professional I tell them I have a patient here that's lost 10 percent of their body weight will you take it upon your soul your back to say that if this patient has cancer and we miss it because you denied the thing the test that it's your fault they said oh well you know if you're worried about cancer maybe we can get it approved I'm like no maybe please get disapproved I'm giving you the rationale this makes a lot of sense they said fine and sadly enough my patient turned out to have a lymphoma and this is not a story that's happened a long time ago this is something very recent we were able to get them in with an oncologist very rapidly the oncologist sent me a message in the electronic health record uh thanking me for doing this and speeding the whole process up because we're able to get the patient in quite early I'm hoping for a good outcome I don't have all the answers yet but because we're able to do this and argue for the patients on the patient's behalf I'm hopeful we get a better outcome I actually had a patient with foot pain that got way worse way more of a complicated case click here to check that out and as always stay happy and healthy [Music]

Dr.

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