Saturday, July 7, 2012

Mystery patients

I used to get excited with mystery patients.

Like a patient would come in with a super low hematocrit and we had no idea why, and I'd actually be curious to figure it all out. Unravel the mystery, so to speak.

Now I'm jaded. I've realized we often never find a good answer to those mysteries. Like at the beginning of my intern year, I had a young healthy patient who spontaneously went into heart failure and nobody ever figured out why, despite the fact that I sent a huge viral panel.

It's sort of like when I used to watch X-Files, back in the day... there would be some really interesting build-up and I'd be really excited to find out the answer to the mystery, but it would always end up being pretty unsatisfying with a lot of loose ends. Ditto with Donnie Darko.


  1. Yep, it's pretty much true. And also why the procedural specialties start to look more appealing. At least then you're actually fixing someone. Sometimes.

  2. The autopsy/post-mortem examination doctor should get back to you, to tell you the cause of death, no?

  3. Yep... I am a mystery patient, and it sucks.
    The best one was where I saw a NP and she said "we're just going to keep trying different things until we find something that works", and after the first thing didn't work she said "oh well, good luck with that"

    Good news: After 5 years of having a mystery problem that was ruining my life (it was hypothyroid), I went to an Indian/Chinese medicine guy and he gave me a combination of herbals that fixed me right up!

  4. Perhaps the reason I'm interested in family med is that the long-term relationship with patients might mean I actually get to find out the answers to some puzzling patients, even if I'm not doing the testing myself.

    I have a 'zebra' patient in my family, and recently suggested something (Cushing's syndrome) as a possibility for a collection of seemingly unrelated issues. Their GP agreed to do the testing since it does fit. Awaiting lab results now to find out if I was right. It'll drive me nuts if that's not it, and I'm not even a doctor yet.

  5. The worst thing about "mystery patients" is that if you DO find out the answer, it's rarely anything treatable.

  6. Now add in a patient that can't tell you what's wrong and you have my day in a nutshell.