Social Worker: It takes a strong woman to do that.
Me: To do what?
Social Worker: To admit the patient the way you did it. No consults, no head CT...
Me: Uh, what would most people do in this situation?
Social Worker: Most people would have had him admitted to internal med, then they would have called a neuro consult, ordered a head CT, and ordered an EEG. Probably a prolactin level as well.
Me: He is a 20 year old guy with a history of seizures who had a seizure after being up all night playing computer games. Had I been able to reduce his shoulder down here [in the ER] then I would have sent him home from the ER. The only reason I'm admitting him at all is because we need to go to the OR to do a reduction of his shoulder.
Social Worker: Most people would have done more of a workup for his seizures.
Me: Why does he need a workup? He has a history of seizures. He had a seizure. The last time he had a seizure it was because he was up all night. He sees his neurologist regularly. What is there to work up?
We reduced his shoulder dislocation and I sent him home from the recovery room. Go go modern medicine.
I agree with you. No seizure work-up is indicated. Tell the social worker to mind her own business.ReplyDelete
Unfortunately the social worker is right. I work with people with disabilities. My main "seizure" guy has lots of falls....and lots of different doctors, including neuro. Every single doctor, every single visit I have to state "he will never be seizure free". Since birth, 44 yrs old. And when he had a seizure at a ball game with his stepdad....Geez, med levels & talk of changing meds. Thankfully the stepdad said No....call his caregiver.ReplyDelete
I think the social worker wanted a seizure workup and was questioning Fizzy's treatment plan.Delete
Agreed. Most ER doctors wouldn't do a work-up in that scenario. Agree with Grumpy that SW needs to mind her own business.Delete
I wasn't clear. ...Fizzy was right & I think unusual. I hate that every doctor including the podiatrist question my clients seizure treatment. That the ED doc wants to change meds. I understand making sure the patient is in active treatment but geezDelete
Oh man...workup aside, I feel for the guy. I've been admitted twice because they couldn't reduce my shoulder in the ER and had to wait for an OR. Mine weren't due to seizures, but it was an very painful wait, even with narcotics on board.ReplyDelete
Social workers perform an indispensable service in the hospital, but they are not doctors! Recently I was yelled at by SW for following treatment plan A vs. B. After explaining the rationale to her calmly, she continued to berate me. At the SW in this story didn't yell. Oh yeah, she was wrong too.ReplyDelete
Yay another doctor with a brain!ReplyDelete
thank you for keeping healthcare costs and allowing his outpatient doctors to do their jobs (chronic seizure management) yours sincerely, your friendly local neurologistReplyDelete
Fortunately the SW's at my centre would never make a comment like that. A prolactin level? Why? Did the social worker examine the patient and find evidence of bitemporal hemianopsia? Does the social worker know what this is?ReplyDelete
Prolactin levels are elevated after true seizure activity and its absence may suggest an alternate diagnosis.Delete
Does not have to do with a pituitary adenoma
Seriously, the social worker does medical management too? Did she Google the patient's symptoms? Or does just hanging out with medical people qualify her as an expert? Tell her to do her job and let you do yours! Aye!ReplyDelete
Wow, a social worker?! As a podiatrist, I wouldn't dare contradict a physician.ReplyDelete