Thursday, August 9, 2012

Gems from Psychiatry Consult

Of the following things on a 20 year old patient's problem list, what do you think is the highest priority:

1) the patient suffered a vertebral fracture at C5

2) the patient is unable to move either of his arms or legs

3) the patient is intubated

4) the patient has oxygen sats going down into the 80s

5) the patient is incontinent of bowel and bladder

6) the patient MAY have ADHD

If you ask me, I think the ADHD is top priority, for sure.

And that was one of the bullshit consults I got while doing psychiatry consults as an intern.

I had a long discussion with my attending about ADHD (formerly, ADD). He thinks that it's highly overdiagnosed, which I would agree with. One thing I've been noticing recently is that a lot of adults I know are getting diagnosed with it. My attending feels that anyone who's made it through a quality college couldn't possibly have ADHD. I'm sure a lot of people would vehemently disagree with this.

Personally, I've noticed my attention span is not what it used to be. It's become very hard for me to pay attention to a lecture from beginning to end. But in my case, it's more likely due to fatigue.


  1. Huh. I can't sit and watch anything on tv for longer than 25 minutes anymore. Do you think I have ADHD? Can I have some ritalin?

  2. I agree that it is overdiagnosed these days. A relative of mine was examined for ADD 20+ years ago and was given a long battery of tests and 4 prescriptions for ONE pill each, 2 of which were placebos. Then his mother had to report to the doc the behavioral results of the meds and then he went to the office and re-took certain tests with the med that seemed to be best for him. THEN he was given a diagnosis and a prescription.

    But for serious, would you be worried about the oxygen sats first? That seems like a complicated situation

  3. *facepalm*

    "Quick get intern Fizzy! This guy can't move, speak or poop on command and the way his sats are dropping it might become a permanent state. But by God, Fizzy will find out if he's ADHD!"

  4. Hard to pay attention when you are hypoxic.

  5. I have a friend who killed it at the University of Michigan in an engineering program (won't say which one), entered a PhD program, and all of a sudden was on ritalin for ADHD. Because apparently he/she has crazy ADHD and his/her doctor was appalled that it took him/her so long to get diagnosed.

    At this rate, I think my entire med school should be prescribed ritalin, because if I can't sit down and memorize muscle origins/insertions for more than 6 hours at a time I must have ADHD...

  6. It was an attending that had told me, "You definitely have some ADHD." But the definition of a psychiatric illness is that it negatively impacts one's life - so I totally agree with your attending. No matter how I attentive or scatterbrained we are, it's not possible to be a physician with the kind of ADHD some of our patients have.

  7. AMEN!!!!!

    One of my most favorite psych consult requests from ob/gyn: "Pt is a 24 y/o female s/p NSVD and s/p ouji board 2 years ago, please evaluate for safety to take baby home."

  8. I do have ADHD. I was able to compensate all the way through high school, college and med school by studying crazy long hours, compared to my classmates. When I got into residency I started to hit the wall, and my program sent me in for testing.
    While it is overdiagnosed, it is equally a mistake to go the other way and say almost no one has it.

  9. After 1 week of dealing with my ailing mother. . . . how would you like this coming into your OR suite. . .
    84 yo caucasian female, CHF, pacemaker, HX stroke, recently recovered pneumonia, atrial fib, dementia, FX FEMUR.

    Yeah, I am basically my mother's mother!! But she did get through the fx reduction. Spinal, plate and screws and she is still ticking. Must be that pacemaker that keeps her the energizer bunny.

    Me--I am totally emotionally exhausted. Headed for the spa in the AM. Got to take care of myself!!!!!!!!!!