Thursday, October 20, 2011

Which is worse?

Which of the following would you be least excited to see on your patient roster:

a) Patient over age 80

b) MMP = multiple medical problems

c) Six or more medications, one of which is Vicodin

d) History of substance abuse

e) Nursing home patient

f) Non-English speaking

g) Chief complaint contains words “chronic” and “pain” in it, and possibly “back”

h) Chart is Volume 15 of 15


  1. I admitted that patient yesterday, except he spoke English. Oh wait, it's possible to have a patient who meets just one of those criteria?

  2. What sd said.

    I think the non-english speaking ones are the hardest since I am an ignorant american who only speaks english (well).

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  4. One with all of the above... Good luck!

  5. I) multiple allergies inlcluding panadol, NSAIDs, sticky plasters, morphine, endone, guessed it all they can have is pethidine!!

    1. They also always have Irritable Bowel Syndrome (not actually diagnosed, just suspected) and Chronic Fatigue (undiagnosed but suspected) and Fibromyalgia (strongly suspected).

  6. My patients have at very least 3 of the above. The non-english speaking doesn't count because i'm not in a english speaking country.
    Having a patient that doesn't speak your native language (or any other language you can even scratch a bit) is probably the most terrifying thing for me. I remember a patient I had a couple of months ago with impaired hearing and who could only speak swahili. His relatives rarely visited him and I remember thinking a lot in a way to communicate with him other than gesturing. I talked about this with a friend and came up with a ridiculous solution:

    Me: I have a patient who only speaks swahili.
    Friend: Isn't "Hakuna Matata" from lion king swahili words?
    Me: Dunno. What does it mean?
    Friend: "don't worry", i think.
    Me: Hmm, I don't think it will be that helpful. He has TB, he should worry.

    Eventually I tried it out, and the patient did smile... but that was probably because I mispronounced it in some way i'm not fully aware of.

  7. Presuming it's not all one patient, I'm going to order them as follows (top being the one I least want to see as a hospitalist):

    (If you eliminate the over 80, nursing home, MMP patients, my service would be very small...)

  8. 8 reasons why I'm going into pathology

  9. Can I answer "all of the above"? This is why I chose pediatrics...

  10. oh god G. hands down. especially if it's fibromyalgia.

  11. 6 or more meds? Dude. Where I work I'm happy if we can keep the medication form to a single page. 4 or less and you're the model of health.

  12. Recently admitted a patient with the following problem list:
    -Chronic pain syndrome
    -Chronic REGIONAL pain syndrome (believe it or not, this is different, ICD9 code and all)
    -Carpal tunnel
    -Restless leg
    -s/p T10-L1 spinal fusion for pain
    -Severe alcoholism
    -Chronic pancreatitis
    -Takes ibuprofen 200x16/day 'for pain' x2.5yrs

    I think I had a small STEMI reading it.

  13. Is it bad that each patient on my service currently has >75% of these?

  14. I think my daughter is probably B and H (and C minus the Vicodin). LOL.

  15. I have B and C, minus the vicodin. This is why I take my doctor baked goods.

    My favorite thing to hear from a doc is "you're on a lot of medications." Most of the time I manage to bite my tongue and not congratulate them on their grasp of the obvious. I didn't ask for it, and I don't enjoy it, but I'm guessing it's also a bit of a pain for the doc to deal with, so I try to keep my snarkiness to myself.

  16. i) the chief complaint appears to be something about "Elbow" or "Ebola."