One of our intermittent hospitalists previously worked in suburban and urban hospitals, and has found our two-ring rural circus a bit challenging. I knew he was settling in nicely when he told me the following story:
A 40-ish man was admitted with unexplained altered mental status. When the hospitalist examined him, he was somnolent and couldn't give any history. Limited neuro exam was unremarkable and urine tox was positive for benzos and THC--not an uncommon finding in our rural county. He was admitted for observation and supportive care.
The next day, the patient was a bit more wakeful but still behaving strangely, and the hospitalist considered ordering a brain MRI. The sketchy history made the patient's ongoing abnormal mental status more worrying than it would be if he had a history of chronic behavioral problems. This is why taking a good history is essential: it puts current symptoms into context, which helps narrow the spectrum of differential diagnoses a doctor must consider.
The hospitalist was still wrestling with this conundrum when the charge nurse brought him a copy of the local newspaper. Below the fold of the front page, there was a story about a 40-ish schizophrenic man who was wanted by police after a minor assault. Lo and behold, there was the patient's name and a handy mug shot.
So no MRI was ordered, the patient recovered a (relatively) normal mental status the following day, and hospitalists around the country learned a useful history-taking tip. I was already familiar with this one: I check the police reports and obituaries regularly for stories about our frequent flyers and problem cases.
same planet. different world. i don't watch the news and seldom read newspapers. the last weekend i covered at the state hospital there were 7 gunshot wounds. not one made the news.
i think we are all jaded here. to bother to call the police when we know they don't care is also something we don't do.
Posted by: bongi | April 10, 2009 at 02:07 AM
Nice investigative work. :)
Posted by: Dr. Val | April 09, 2009 at 09:52 AM
I totally agree. When I was on my trauma surgery rotation 3rd year for two months, I would put on the news at night and see the patients that I would be rounding on the next morning...
After the rotation was over, I was watching the news and I saw one of my attendings from a news helicopter. Turns out, he and two of his residents flew out to a crash on a major highway. A woman's legs were pinned under a truck. He bilateral BKA'd her on the highway and saved her life all while standing in a pool of diesel fuel!
Pretty amazing feat, but maybe another reason to go into family medicine.
Posted by: David Magness, DO | April 07, 2009 at 11:54 AM
Good idea. I had never thought of that.
Posted by: Half M.D. | April 06, 2009 at 01:04 PM