Nurse Yankee working up one of my well-child check patients: Any concerns about baby today?
Patient with infant: Hers got a sick muu muu.
Patient: You know, a sick…down there.
Nurse Yankee: ma’am, you’re an adult, your kid is too young to know what you’re saying, and I don’t have a damn clue what you’re talking about. What is wrong with her?
Patient: she’s scratching her privates.
Nurse Yankee: again, be specific here. Are we talking front? Back? Everywhere? Help me out here.
Patient: See I got this discharge…
Me: Mmmkay, what color is it?
Me: does it have an odor?
Patient: It smells like trash.
Nurse CP and I walk into exam room where mom, dad, (both very young) and young daughter are all playing with various equipment in the room.
Mom is listening to dad’s heart (on the wrong side of his chest) with a stethoscope.
Dad is banging his knees with the reflex hammer.
Child is attempting to examine her own eyes with the ophthalmoscope.
CP: NO MA’AM! Lil girl, put that scope down!! Yo mama can NOT pay for that if you break it. Mama and daddy, you need to put down the toys too and help me hold her for this shot.
Mama and Daddy:
Me giving basic dietary advice to an intellectually disabled (this is the new PC term) patient with uncontrolled diabetes…
Me: Would you like to go back to diabetes education class? Would that help you? Maybe a one-on-one session with someone who can help you with your diet?
Patient: Yes! I wanna do that! Are you gonna put me on a diet, doc?
Me: Well, I want you to eat healthier so we can get your sugar and your cholesterol controlled.
Patient: So what am I not supposed to eat? I like TV dinners and catfish and hushpuppies and yesterday I had three baked potatoes and…
Me: Well the dietician will go into a lot more detail than I can right now, but let’s say for now just try to eat very few foods that are white or that have sugar in them. Stuff like potatoes, rice, pasta, bread, and sugary drinks.
Patient: What about chicken? Chicken’s white.
Me: Chicken’s ok, just not fried.
Patient: What about coleslaw? It’s green and white.
Me: Every once in a while, it’s fine. But remember that mayonnaise is white, so that’s a food we need to avoid.
Patient. K. What about milk? I like milk. Milk is white too.
Me: Milk is good for ya. You can have milk.
Patient: What about chocolate milk?
Me: Well think of chocolate milk like you think about sodas. That’s a lot of sugar.
Patient: BUT IT’S BROWN!
Me: You have a point.
Me, to patient who I have seen in the office at least half a dozen times and am now seeing in the hospital: Hey there! Let’s take a peek at baby!
*Wayfaring does full exam on newborn*
Patient: so what’s your name? Are you my nurse for the night?
Happily (?) married man with a deaf wife.
I saw this lady in clinic recently who had neck pain. She said, “I feel like something’s wrong with my neck veins. There’s something pulling in my neck.” I was fairly certain she just had a muscle strain, but I listened to her carotids to assuage her worries about her neck vasculature. I mean, she was in her 60s, was a smoker with hypertension, and was obese. That warranted an exam, I thought. Sure enough, in addition to her muscle strain, she had bruits over both carotids, although it was much louder on the left. (Bruits are like heart murmurs over blood vessels…they are a shwooshing sound you hear when blood flow is turbulent from narrowing arteries). Her only symptom that could be attributed to the bruit in any way was frequent headaches. I told the resident that I found the bruit, and she listened and agreed. She noted that there was no record of it in her chart before. We sent her for a carotid ultrasound just to assess the degree of stenosis in her carotids.
For my non-medical friends, if your carotids become too narrow, you end up cutting off blood flow to the brain and get a stroke. A lot of times there are no symptoms beforehand; sometimes people present with transient blindness, speech problems, or facial weakness.
Anyway, today I got the following text message from the resident I was working with last week:
"Remember the lady you saw in the office last week with the carotid bruit? I just got a stat page. She had her U/S today and it found 80% stenosis on the left and she is going to vascular surgery immediately today. You really may have saved her life! Good job! I’ll let you know how it goes."
So yay me. It’s amazing the good you can do just by doing a simple physical exam!
UPDATE: After the resident mentioned above graduated, this patient was assigned to me (because of this very encounter as a medical student). On my first visit with her as her PCP, we discussed her carotid disease. As it turned out, she had refused surgery in 2011 because she believed that her carotid stenosis was not a problem (and actually, we don’t recommend surgery for asymptomatic carotid stenosis). The resident who was her PCP at the time continually tried to push her to have surgery, but with no success, so she maximized her medication therapy, hoping it would be enough to slow the progression of her stenosis.
During our visit, I asked her about several specific stroke symptoms. After inquiring about episodes of blindness, she said, “yeah, actually I get this brown sheet that comes down over my eye and stays there for about an hour and then it goes away. That’s my cataracts, right?”
I explained to her that cataracts cause slow progression of blindness with haziness of the vision, not a “curtain pull” effect, and that these episodes were indeed caused by her carotid stenosis. I emphasized the fact that since these episodes were becoming more frequent, she would most likely become permanently blind or would have a larger, more debilitating stoke in the very near future.
She finally agreed to see a vascular surgeon, and now, just over 2 years after our initial encounter, she has had her endarterectomy! When I got the report from the surgeon, I had a little celebration at my desk. This is why persistence, continuity of care, and good follow up with a PCP matter.
There is a special place in hell for people who bring paper towel wrapped bodily secretions to the clinic for their doctor to examine.
I do not need to see your giant booger, your weird poop color (unless you are a baby—then diaper exams can be helpful), your quarter-sized menstrual blood clot, or your sputum sample. Use your words. A simple description is usually enough. If I need a sample, I will ask for it, I promise.
Pregnant patient’s first question about the labor process
Pregnant patient whose hair color is wildly different at every monthly office visit states she quit taking her prenatal vitamins because they were making her hair fall out.
Me to inpatient: Good morning! How are you feeling today?
Patient: Oh, since you didn’t get to see it yesterday, I found the picture of my rectal prolapse on my phone! See?
*thrusts picture taken from the toilet with a full toilet bowl in the background into my field of vision*
Patients get embarrassed in front of me all the time, but the things that embarrass them (getting pelvic exams, talking about their bowel habits, having their feet examined for some strange reason) don’t embarrass me. It’s just work to me.
Hmmm… I had one patient loudly declare her preference for anal sex in the ER recently. But she didn’t seem embarrassed about it. Her mom did though ;).
Ooh, also I did a rectal exam on the father of a baby I delivered last year. The baby’s mom was in the room at the time and commented that I was getting to know their family a little too well.
Nurse: *sees patients name on chart with 5 middle names* Do you really have 6 names?
Patient: no, I actually have 12.
Nurse: *looks at mom* how did that come about?
Mom: I just couldn’t decide on a name when I was pregnant so I used all of them. Officially she only has 4 middle names though cuz that’s all they could fit on the birth certificate.
Me, to kid (and mom) with ankle sprain: So when you go home, you need to keep your leg elevated and put ice on it a few times a day. We’ll wrap it up in a brace before you leave.
Patient, a 10 year old boy very proud of his new football injury: Oh yeah, that’s an old high school trick. Wrap it up and put ice on it. That’s what my buddy on the high school team told me to do. Probably gonna need to tape it up for practice.
Me, mom, and attending: