jmj11 Posted October 30, 2015 Share Posted October 30, 2015 Here is one that happened again today: Patient walks in "I really don't need an appointment, I just need to drop by and talk about some problems I've having, get some refills and get some paper work for my work." Hmmmm . . . what are "appointments" for? I think what they are really saying is, " I want 30 minutes of your time in the middle of a busy day, for free and so that I don't have to pay my $10 co pay." Link to comment Share on other sites More sharing options...
winterallsummer Posted October 30, 2015 Share Posted October 30, 2015 Chronic pain pt on my ward for an infectious disease. "Can I get 3 mgs of dilaudid to help me sleep tonight?" No sir that is not what dilaudid is for and we don't even give dilaudid for this infectious disease you're in here for. "But I'm in pain..." Take into consideration I had to wake him up once I came into the room to do his exam. Yes chronic pain indeed. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 30, 2015 Moderator Share Posted October 30, 2015 I have a high pain tolerance(meaning just the opposite) I take a yellow pill with some numbers on it, you know the one the only thing that works for me is X I'm immune to amoxicillin my regular dr always gives me X Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 30, 2015 Share Posted October 30, 2015 Yesterday - "If there is a 0.3% of patients who have a certain side effect - that's me. So, you better be careful with meds." We were talking about Seroquel........ I was beginning to wonder which personality I might be talking to and if others had fewer side effects. She had somehow already taken Lamictal WITHOUT getting the rash. I began to feel more normal after that one. Elderly male asked me - the new PA in the family practice replacing a doctor who retired - when they were going to hire a real doctor. I VERY politely told him I was the new primary care provider and had many years of experience. He shook his head and said "I just don't know what this world is coming to". Super angry type A super A-hole coming in after a psych consult in the ER for anger and depression. "I don't want to talk to anybody. I just want a f'ing pill". Then he stormed out of the building when I said the treatment plan included more than pills. "I only take my blood pressure pills when my pressure feels like it is high"................ "Every time I get a flu shot, I get the flu" Deep Sigh Link to comment Share on other sites More sharing options...
greenmood Posted October 30, 2015 Share Posted October 30, 2015 Pt: That shot they give me really helps my pain. Me: Which shot? Pt: The one in the arm and sometimes in the belly. *shows me bruises* Me: That's heparin sir. But, I'm glad it helps your pain. It was actually really cute. Link to comment Share on other sites More sharing options...
sas5814 Posted October 30, 2015 Share Posted October 30, 2015 My liver hurts.. I am allergic to all antibiotics... I had something for pain that worked. It was v something vi something (I just shake my head and look confused.) My pain is a 10/10 (while laughing and playing on her phone) I went to the ER and they didn't do nothing! Did they take your vitals? Yes. Did they examine you? Yes Did they do tests? Yes. and what did they tell you? Nothin...they didn't do nothin! Actual text from answering service at 2AM Sunday morning. Pts mother wants a call right away. She is in the ER with her son and says all they did was a CXR, some blood work, and give him a prescription and she wants you to straiten them out because he needs more...and no she can't wait until the clinic opens tomorrow. Actual conversation in answer to 3AM call. I am all broke out in hives. Do you have some Benadryl? I don't have no Bendaryl and no money to get none! Perhaps you should go to the ER. I'm not getting out on that highway! Its a death trap out there! Maam what did you expect me to do over the phone at 3AM? *SLAM* Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 30, 2015 Share Posted October 30, 2015 "My foot is killing me. I need pain meds." "You have a pain contract with Dr. Oz. You are already on Hydrocodone 10's 4 times a day" "That is for my neck. It is my FOOT that hurts. It is different." As if the pain meds know which part of the body to help and can actually ignore other pain receptors......................................... Nanobots anyone?.......................................... Link to comment Share on other sites More sharing options...
sas5814 Posted October 30, 2015 Share Posted October 30, 2015 I'm allergic to all NSAIDs. Just because PA also stands for passive-aggressive I start naming them one by one and going through a comprehensive evaluation for their allergy. What happens? How long after you take it? How long did your symptoms last? What did you do to get better? On and on.... Link to comment Share on other sites More sharing options...
winterallsummer Posted October 30, 2015 Share Posted October 30, 2015 Yes here are some little know mathematical formulas for medicinal use. If a patient has 4 or more allergies they are probably crazy. Six or more and they're definitely nuts. How to interpret 10/10 pain: 1) subtract 2 points for on cell phone 2) divide in half for normal pulse and respirations and SBP < 220 3) subtract one point for each item at bedside: bag of Cheetos, turkey sandwich, Starbucks cup, pack of cigarettes (purchased on way to ER) 4) finally subtract a point for each of the following: cries only when you enter the room, any type of elective back Surgery in the past, has > 3 specialists and "no one can figure me out", has received more than 3 CTs in the past year How to tell if a patient has bacterial cause of illness: if they have completed 2 courses of antibiotics in the past month and are "still sick", it's viral. Direct them to the nearest urgent care center where they can try a third round. The Hospitalist Severity Scoring System: CP+DBN+FC + DIH = score Award a point for CP if pt is always on Cell Phone when you round, two points for DBN if they know Dilaudid By Name, one point if they have more than Four Consultants, and one point for each Day In Hospital for DIH. Unless DIH is the only item patient awarded points for, discharge all patients with score > 5 for non emergent PCP follow up. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 30, 2015 Share Posted October 30, 2015 My nurse used to draw a tiny little spaceship on the tear off portion of the billing sheet. Then she added the letters IPV. "Interplanetary Visitor" If she added "no visa" - I knew I was screwed. I often wondered if some of my patients had little antennae hidden in their hair.................................... Link to comment Share on other sites More sharing options...
UpRegulated Posted October 30, 2015 Share Posted October 30, 2015 Pt. that called and said he can't afford $45 for Advair for his COPD (but smokes 2 PPD) Pt that said that "hydro's" were the only thing her previous doctor found that helped her pseudoseizures. Rates pain 12/10 "You take real good care of me. Got a bag of some great stuff at home. Stop by the house and I'll share some with you." Pt came in with BP 210/120, started her on meds, told her to FU. Told me should couldn't FU because she can't afford her $25 co-pay with her iPhone laying next to her on the exam table. Pt with "really bad" anxiety, had heard about something that started with "cl" "clom" or "clon" or "something like that." Left room, looked her up, found she had gotten 60 klonopin the day before at another clinic 5 miles down the road. When I returned and told the patient this, her face turned bright red and she says, "Oh, is that what they gave me?" Link to comment Share on other sites More sharing options...
Guest Paula Posted October 31, 2015 Share Posted October 31, 2015 Male patient with testicular lump. "yesterday it was hard, today it is softer....kind of like a ...you know....a sausage" Me: (giggling silently in my brain with the almost uncontrollable urge to burst out laughing with tears forming in my eyes as I hold it all in). Sir, I'll get this checked out for you. I literally ran to my office afterwards, shut the door and laughed almost uncontrollably for about 3 minutes. You had to be there. Link to comment Share on other sites More sharing options...
jdenning Posted October 31, 2015 Share Posted October 31, 2015 I hear all kinds of craziness on a daily basis but one of my all time (and actually rather endearing) favorites was from a little lady with advanced Parkinson's disease who told me that she failed hospice because she didn't die Link to comment Share on other sites More sharing options...
JFarnsworth Posted November 1, 2015 Share Posted November 1, 2015 Too funny! Here's a few: 70+ y o female-"I have a terrible rash all over my arms, and it comes and goes" -ma'am, those are bruises 40 y o female, who came to her appointment in Eeyore pajamas, dishwashing gloves, and a mask- "I have Norweigan scabies, I can hear them moving around, and I have a fungal infection in my nose. I've done back to back Ivermectin treatments 3 times, and now my regular doctor won't give me any more"". Upon examination there was a large hole in her nasal septum, a total of three 2 mm erythematous papules (one on the leg, one on the arm, one on her neck), and then she proceeded to rub her epidermis, show me the little roll of skin, and say, "There, you see? That's a scabie". I carefully collected it and sent it to pathology. Dx: epidermal cells. Botox patient: "I cannot have any bruising whatsoever, because my boyfriend is 9 years younger than me, and if he knows I do this kind of stuff, he might figure out that I'm not as young as I told him I was. Can you guarantee no bruising?" Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 2, 2015 Moderator Share Posted November 2, 2015 My liver hurts.. I have actually found this one might be reliable..... Link to comment Share on other sites More sharing options...
DogLovingPA Posted November 3, 2015 Share Posted November 3, 2015 I take a yellow pill with some numbers on it, you know the one This one kills me every time......They always look at me in disbelief over the fact that I don't know which medication they are talking about.... Link to comment Share on other sites More sharing options...
Joelseff Posted November 4, 2015 Share Posted November 4, 2015 Me to mom of child presenting with congestion, cough etc: "has he been using his Flonase?" MoC: "no because his congestion is SO BAD I didn't want to give it to him..." Me: Sent from my S5 Active...Like you care... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 4, 2015 Moderator Share Posted November 4, 2015 Yes here are some little know mathematical formulas for medicinal use. If a patient has 4 or more allergies they are probably crazy. Six or more and they're definitely nuts. How to interpret 10/10 pain: 1) subtract 2 points for on cell phone 2) divide in half for normal pulse and respirations and SBP < 220 3) subtract one point for each item at bedside: bag of Cheetos, turkey sandwich, Starbucks cup, pack of cigarettes (purchased on way to ER) 4) finally subtract a point for each of the following: cries only when you enter the room, any type of elective back Surgery in the past, has > 3 specialists and "no one can figure me out", has received more than 3 CTs in the past year How to tell if a patient has bacterial cause of illness: if they have completed 2 courses of antibiotics in the past month and are "still sick", it's viral. Direct them to the nearest urgent care center where they can try a third round. The Hospitalist Severity Scoring System: CP+DBN+FC + DIH = score Award a point for CP if pt is always on Cell Phone when you round, two points for DBN if they know Dilaudid By Name, one point if they have more than Four Consultants, and one point for each Day In Hospital for DIH. Unless DIH is the only item patient awarded points for, discharge all patients with score > 5 for non emergent PCP follow up. it's like the crap score: http://allnurses.com/emergency-nursing/the-c-r-220066.html Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 I started my career with a rock and roll spine surgeon - don't ask…. We used the whole body pain drawing - where ^^^ meant stinging or stabbing or whatever **** was numbness, etc - and the patient was supposed to draw in his/her face. I was taught that if they drew OUTSIDE the body lines - beware - such as lightning bolts going into the skull or daggers or such. If they wouldn't draw their face - depression 100%. If they drew a grotesque face with hyper exaggeration - personality disorder. If they used more than one color of ink - way too much time on their hands to think about pain. If there was no part of the body without any marks - don't go in the room. The 10 point scale is so absurd to me - almost as bad as the chart with the creepy smiley faces on it. I tell my patients that 0 is a great day and everything is okey dokey. I say 10 is so severe that death is an option. They still pick 10 sometimes. In my sick twisted dark part that I don't let out in front of the patients - I have always wanted to pull out a 9 mm when they respond with 10 or 12 or whatever and ask them if they prefer 2 to the back of the head or one in center mass….. Now, Medical Home wants a mood chart. Seriously - ask every single patient - UTI, strep, chest pain - whatever - ask their mood. My response: Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 I am trying to insert a graphic and it keeps coming up blank……… GGGRRRRRR Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 Let's see if this sticks. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted November 4, 2015 Share Posted November 4, 2015 So much for comic timing….. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 5, 2015 Share Posted November 5, 2015 Now I know why RealtyCheck2 has the cat avatar. ROTFLWTIMEs. Means rolling on the floor laughing with tears in my eyes. Link to comment Share on other sites More sharing options...
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