Honestly, I understand why a physician might not want to seem nosy or asking inappropriate questions of a patient. But seriously:
Asking your patient why they don't have legs is a relevant part of the medical history.
I was supervising a resident doing an EMG the other day and I was shocked to enter the room and discover the patient was a bilateral above knee amputee. Granted, the patient came in for numbness in the hands, but I was still baffled when she didn't even ask the woman why she didn't have legs. I mean, at least mention it when you're presenting the patient so my jaw doesn't drop open when I see her.
Once upon a time, my ambulance was called to a nursing home. Our patient was bundled under tons of blankets on his bed. We went to transfer him (and all of his blankets) over from his bed to our stretcher via sheet transfer (untucking his bedsheet, and sort of picking him up by it, and "carrying" him to the adjacent stretcher). The nurse giving us report failed to mention that he was a bilateral above knee amputee, so we were kind of expecting the weight to be distributed like an average person. Well, we were wrong, and nearly flipped the poor guy over in the process. He was a good sport about it at least...I felt terrible.ReplyDelete
I was seeing a patient in the ER who did not have any legs, and it wasn't pertinent to his complaint necessarily, but like you said... Anyway we get to past medical hx and I'm all "what medical problems do you have," and he's like, "Oh I have some seasonal allergies, nothing much," and the whole time I'm thinking,Dude, how about the part where HALF of your body is completely missing?! I had to ask directly. Please, don't make me do that.ReplyDelete
Numbness in the hands... neuropathy?ReplyDelete
Legs amputated... possibly due to gangrene which occurred due to diabetic ulcers?
Just a wild possibility.
Could be related after all...
So I agree. It's not a matter about curiosity, there are some questions docs are SUPPOSED to ask.
Definitely have to ask. Just "what's going on here?" will usually suffice. In EM it's almost always a possibility to be related. Early sepsis or other problem at the amputation site etc. Sometimes they don't know there is a problem especially if there's a proximal loss of sensation or if they have normal pain/parasthesia and don't know the difference and can't see it to check (or don't think to).ReplyDelete
So yeah, not asking for whatever reason is a problem. I'll occasionally send residents back in to ask if they did not before. (after they sit down to do orders of course)