Friday, March 16, 2012

You might be crazy (or not)

A valuable lesson that I've learned is just because a patient acts crazy (or possibly IS crazy), you can't discount what they say. I offer two memorable examples:

When I was rotating in the ER as a med student, there was an old woman who had this crazy story about being locked in a basement by her family. The story involved tin foil hanging from the ceiling and all the things you'd associate with someone who was psychotic. But I later found out that when social services checked out the lady's house, apparently everything she said was true. It was a case of elder abuse.

The second story is one I heard from another physician. She said she had this schizophrenic patient who one day said that he couldn't walk anymore because there were "animals eating away his back." The guy was floridly psychotic and everyone kind of wrote him off.

Finally, they managed to get him in an MRI machine. Metastatic cancer to the spine.


  1. This is actually something that worries me about being a doctor - how to tell the liars/hypochondriacs from people who just happen to have an unusual story.

    PS. Have you read the new Sophie Kinsella book, "I've got your number?" - its pretty decent (of course over the top and unbelievable like all her books, but a fun read).

  2. We had a police officer who was suspended for ignoring a crazy lady. She was schizophrenic, but it turned out that she was right about the drug kitchen in her neighborhood.

  3. I remember telling my doctor at one point, when I presented with symptoms of not being able to catch my breath, that I had been known when under stress to develop a full set of "symptoms" that vanished suddenly with the release of stress...I felt that 'truth in advertising' was important in my case.
    It was written off as stress and I was put on allergy medication - only to find out when a crisis happened that I had asthma and panic disorder... (the panic no doubt partly caused by the fact that I couldn't breathe)
    Lesson learned. Don't volunteer the "potential hypochondria" info.

  4. One of the most memorable lessons from my first psych rotation: Psychiatric patients always die of physical causes.

  5. I'm on psych now, and one of our attendings told us about a schizophrenic patient he had many years ago who came to the ER complaining that her insides were rotting and maybe something about an animal down there too. She complained about how she couldn't eat anymore because it was coming up her throat. He looked inside her mouth and she had this massive ulcer.

  6. It's kind of scary how easily we can stereotype. I keep reading medical blogs where people talk about how they have to deal with morbidly obese people who complain about (insert eye roll here) being short of breath. This kind of stuff terrifies me. Dude, if I tells you that yesterday I wasn't short of breath, the day before I wasn't short of breath, last month I wasn't short of breath, and suddenly I'm short of breath, maybe there's a problem! (Fortunately, the one time I showed up at an ED short of breath the nurse on triage recognized that there was something seriously wrong.)

    But it's not just medical people who do this. Working with computers for 20 yrs you wind up getting dismissive of weird complaints.
    User says: "I'm locked out of Firefox, I can't get to my email"
    What we think: "You forgot your password"
    What it turns out to be: "The disk is failing, Firefox got corrupted due to the bad disk, and now it can't run"

  7. Wow that first example is terrible :S :S, can't believe there are people like that - were the family deliberately using things like tin foil to make the ladys story about being locked in basement sound crazy?

  8. My favorite: I had a gentlemen in with a gi bleed and alcohol withdrawal complaining of bugs in the room. I walked out to the nurses' station and increased his lorazepam, thinking the alcohol withdrawal was not adequately treated. I walked back into his room, and there was a swarm of gnats over the bed.