Thursday, November 04, 2004

I’m not Telling

Last night a patient I had admitted the previous night came back to the Emergency Room with similar complaints. This is what we call a “bounce back”, reason being that the intern who discharged her yesterday is now going to have her “bounce back” to his service. Well, my bounce back was there for her second seizure in two days. The first time she came in she had signs of a possible urinary tract infection to boot and I treated that. However, now that she came in the second time I was wondering if her infection could really be meningitis (a deadly infection of the fluid that surrounds the brain).

Of course, the ER attending had asked Neurology to come by and see the patient. They had recommended a CT, MRI, this and that levels etc. So I decided to ask, what the hell.
Me: “Could this be meningitis?”
Neuro: “Well, I suppose it could”
Me: “Should I do a lumbar puncture” (Not a fun procedure to have done)
Neuro: “Well, I guess if you suspect it then you should do it”
Me: “Yes I know that, but do you suspect it?”
Neuro: “Well, it could be meningitis”
Me: “Would you do a lumbar puncture if this was your patient”
N: “I may

One of the major problems for the Housestaff is that Attendings don’t want to commit. Everyone’s afraid, everyone uses words like “could be”, “may”, “possibly”. My last CT scan result said “This may represent an effusion, possible infiltrate, cannot rule out mass”. Well, I figured I’d join everyone else in being as vague about my thoughts as I possibly can. Now when I speak to my friends our conversation goes something like this:

Friends: “What do you want to eat?”
Me: “I’m not sure, I think pasta but I can’t rule out suddenly wanting steak”
F: “How’s the wife treating you”
M: “Consistent with nice, I can’t rule out things going bad though. You mind if I use your bathroom?”
F: “sure, will you be long?”
M: “Well, this is likely a bowel movement but I cannot exclude possible urination. In addition, the cramp is of high intensity and could theoretically be representative of possible future diabetes and a current infection, although unlikely, clinical follow up will be necessary”.

We need a bill to stop ridiculous medical lawsuits. It’s driving us to insanity, case and point.