- I'm coming up on 10 years of being a practicing doctor,
and I've had some incredible patient encounters,
wildest patient encounters, weird patient encounters.
So I thought I'd chair a few of them right now.
Let's get started.
This story still haunts me to this day,
that it happened in the way that it did,
because it really shouldn't have went down this way.
And this happened actually when I was a student
and I was rotating at this medical facility.
And I walk into the room and I'm like, what's going on?
You guys are pretty banged up.
And they said well, we were involved in a car accident
coming back from Florida.
The husband was behind the wheel of the car
and actually fell asleep and ended up crashing the car
at a very high rate of speed.
They said, well we think we're okay.
And we kind of went to the local hospital where we crashed.
They were somewhere down south.
But we felt like they didn't do a full evaluation
that we thought was satisfactory so we came here.
And I see that the male patient has a fractured clavicle.
The female patient has a broken humerus,
and so much so that I think it damaged her nerve plexus
because she has a wrist drop.
There was significant injury that was visualized
on all of these tests.
There were hip x-rays, abdominal CAT scans,
but the one thing that wasn't there which shocked me,
was a head CAT scan.
So I go back into the the precepting room
which is where you talk to all the senior doctors
and I said look, let me dig into this case.
I really looked through all the scans,
I looked at all the records, the intake forms,
and I see that the female patient is on Plavix.
That's a blood thinning medication.
She's on a blood thinning medication,
just got into an accident at a high rate of speed
and did not get a CAT scan.
This is definitely wrong.
I present the case to my attending.
My attending as a family medicine doctor firmly agrees,
says I cannot believe, is outraged,
that we absolutely gotta get them to the ER.
The next day I come into work and I'm so curious
to see what has happened.
I open the medical record to see what happened
with this case.
And I see that those patients left against medical advice,
meaning that they signed a form
saying that I don't want to be here,
that I'm leaving before the doctor has cleared me to leave.
The ER doctor said that the family medicine doctor
doesn't know what they're talking about.
You're fine now.
It's been over 24 hours since your car accident.
Because you're not showing any symptoms,
there's no use to getting a CAT scan,
and that you're gonna be fine.
And I'm like look, this is gonna sound really annoying
but I think you should go back to the ER.
They're like well look,
can we talk to your senior physician?
I'm like he's not here today but as a med student
I'm telling you, you really should go to the ER
because you are on blood thinners.
Your husband wasn't in great shape either.
I really think both of you need to get scanned,
and because I have another attending physician
that's here right now in the hospital,
we can meet you and get you scanned
even if the ER doctor this time says no.
The female patient has actually been admitted
into the neuro ICU 'cause it turned out that after getting
the CAT scan,
she was actually having a very slow bleed into her brain
as a result of being on the anticoagulation medicine Plavix.
And they had to do an emergency craniotomy,
which is with them opening up the skull
and relieving the pressure.
And had they not done that she could have died
and probably would've died to be honest.
I was like, oh my god,
did I just save a life because of all this?
The craniotomy went well, the neuro ICU stay went well.
Everyone ended up recovering,
all this stuff had a very happy ending.
But because this was what we classify as a near miss,
we actually had to file reports with our system
in the computer where we report these near misses.
We met with the head of the emergency department
to talk about why this happened
and created policies to make sure this never happens again.
I was working in my clinic late one evening
and what I like to do before I start my hours
is actually look through who's on my schedule,
look through what's going on in their medical history
to make sure I'm not missing anything
when I walk into the room.
And I saw on my schedule at the end of the day was
a young patient,
a young girl that was coming in for like a sore throat.
So I didn't think anything of it.
When I look later in the day,
that patient switched to a different patient,
a male patient with a very similar name.
When I walked into the room, I right away got a little bit
of a strange sense that something else was going on
because the patient was acting a little bit reserved.
So I said, let's investigate.
I introduce myself, I start asking the questions,
and the patient abruptly, abruptly shifts the conversation
and says doctor, I have to admit the real reason I'm here.
I'm aware that your mom has passed.
And I'm like thinking, where is this possibly gonna go?
Well, I'm here because I actually have a message from her
to you and I think it's really important that I share it.
And at this moment I'm really confused
because I don't know what to do.
I wanna be professional.
At the same time, I know that this patient
is being unprofessional
and I don't know exactly what my next steps should be.
So I kind of gathered myself and I said,
I appreciate you doing that, but I am here working
and I have to take care of patients who are having illness
and need my help.
While I'm appreciative of the message, I'm not interested,
and I have to move on to the next patient.
I hope that's okay with you.
And to my surprise, the patient goes that's perfectly fine.
I'm okay with you doing that,
but I just wanna say that I need to get that
off my chest and share that with you.
This totally threw me.
But we moved on and we kept taking care of other patients.
I actually have a patient who I've been taking care of
for many years who happens to be a doctor,
and we start talking about their health.
They tell me that everything is in normal working order.
They don't smoke, they drink socially.
Very rare drug use.
They are sexually active, intermittent protection.
This is a male patient by the way.
Look at the lab work and I see that it's all,
it's all looking good.
And then something happens
which I really wasn't prepared for.
I see that the HIV fourth generation test flagged positive.
First of all, it's fairly accurate.
There's not many instances where this test is inaccurate
and they had a very big reaction, tears,
and I understood why tears were coming.
They were very worried.
They didn't know what was going on.
They weren't sure if this was sexual exposure
or if this is a patient exposure.
When I talked to them, I said okay look,
this is a test that needs to reflex to other tests,
and it's likely that those tests are still pending
so let's wait for those tests to come back.
Which then allows us to understand
what type of virus this is.
And again, we're talking about human immunodeficiency virus,
which if untreated can progress to AIDS.
They obviously were very emotional about it.
I said look, go home.
I should have the results by the end of the day.
I'll call you at the end of my work shift.
I see that the rest of the tests are all negative.
I, in my history of being a doctor
have never really seen a false positive
for this fourth generation HIV test.
In this instance, I said before I call the patient back
I probably should do some really thorough research
to give them answers why this was a false positive.
So I pull up UpToDate, which is one of our most used
resources as family medicine doctors
which we use as a reference tool.
And the thing tells me that the HIV fourth generation test
which has changed since my education
which was third generation test, now can flag false positive
in some very specific instances.
One is pregnancy.
Two, if they are taking HIV medications.
Three is if they have an autoimmune disorder.
And then came number four,
if they've recently received a flu vaccination.
Apparently, and this is something that I even learned
in that moment,
there is evidence that when a patient receives a flu vaccine
that they actually develop some antibodies
that react with this agent on the fourth generation HIV test
which can make it come up positive.
But then if you check the rest of the tests
they will all come up negative.
And knowing that this patient
of mine is a healthcare provider,
knowing that I can look into the record
and see when they had their flu shot.
Five weeks before they had their flu shot.
And there we go, we had my answer.
So I called the patient back, told the patient good news.
They obviously requested to be retested just to make sure.
We rechecked in a few weeks
and everything was totally negative at that time.
But that's why it's really important
that when you're ordering tests
you know what to do if it's positive, negative,
or even if you don't know what to do,
you know where to look to get those answers.
So the other day I had a patient who's around 40,
50 years old, and they say doctor,
like I've finally been able to lose around 25 pounds.
We've been talking about them losing weight for some time.
They finally lost the 25 pounds
and I haven't seen them in quite a bit of time.
So I was sharing in their celebration.
I was like, great job.
So happy for you.
How did you lose the 25 pounds?
The patient said, you know what,
I just haven't been doing anything.
I just happened to lose 25 pounds.
And I was like, wait, wait, wait.
You've lost 25 pounds without trying, like unintentionally?
And they said yeah.
How long of a period of time did this happen?
And he goes, it's been about a month, five weeks maybe.
Now all these alarm bells are going on in my head.
And I started asking about other symptoms.
Well, you know, I've been a little bit tired,
a little stressed out with work,
but the fact that I'm losing weight makes me happy.
The patient also mentioned some night sweats.
I also looked at the patient during the physical exam.
The tint of their skin color was a little bit off
than their usual, 'cause I've seen them for three years.
I felt like it looked a little bit more pale.
I need to order some tests to give me reassurance
that you're not really sick.
The patient has a slight abnormality
in their complete blood count and it was like so mild
that maybe some doctors look at it and say no big deal.
I didn't like the whole story.
I felt like there was something more.
So I told the patient that I was feeling this way
and I said look, I think we should get a scan
and rule out that there's nothing else going on.
Something more sinister like cancer.
What does the insurance company do?
Denies the scan.
We send in my paperwork, they deny my paperwork,
so now I have to get a prior authorization.
I called the insurance company, on hold,
talked to one person and another person
and I finally get a peer-to-peer,
which is I'm talking to someone
who's also a medical professional.
I tell them I have a patient here that's lost 10%
of their body weight.
Will you take it upon your soul, your back,
to say that if this patient has cancer and we miss it
because you denied the thing, the test,
that it's your fault.
They said oh well, you know, if you're worried about cancer,
maybe we can get it approved.
I'm like no maybe, please get disapproved.
I'm giving you the rationale.
This makes a lot of sense.
They said fine.
And sadly enough, my patient turned out to have a lymphoma.
And this is not a story that's happened a long time ago.
This is something very recent.
We were able to get them in with an oncologist very rapidly.
The oncologist sent me a message
in the electronic health record thanking me for doing this
and speeding the whole process up
because we were able to get the patient in quite early.
I'm hoping for a good outcome.
I don't have all the answers yet
but because we're able to do this
and argue for the patient's, on the patient's behalf,
I'm hopeful we get a better outcome.
I actually had a patient with foot pain that got way worse,
way more of a complicated case.
Click here to check that out
and as always stay happy and healthy.
(funky music)