Sunday, November 23, 2008

Consult Rage
I had my first bout of consult rage last week. It is sort of like road rage but instead of wanting to tap on the window of some horrible or overly aggressive driver and ask them what they could possibly be thinking, it makes you want to call up a doctor and ask them where they went to medical school. It probably didn't help that I was called to see they particular patient just before I should have been sent home.

I was on call for neurology and was asked to see a guy in his mid-60's (details have, of course been changed to protect anonymity). He had been in a car collision a couple of days previous after blacking out (most likely syncope from 3 different hypertension medications) and running a red light. He had come to emerg and check out fine. The next day he saw his family doctor and promptly sent back to emergency for left sided "weakness". He was seen by neurosurg, had a head CT and C-spine x-rays and had been signed off.

And yet they still consulted neurology. I can only presume that they thought this left sided "weakness" was due to a stroke. Except he did not have weakness and never did. English was his second language and when he said weakness he just meant he couldn't use that side properly due to pain. This took me all of 30 seconds of extra questions to figure out. On motor testing the strength was fine, just limited by all the bruising from the collision. So neurology was consulted on a patient already deemed healthy by neurosurg that had no neurologic symptoms.

I might not have been so upset except for the extra hour (mostly spent waiting to review first with the resident and then with the attending) it kept me away from home.

On the up side that patient thanked me for being the nicest doctor he had seen in the 26 hours he had been in emergency.

1 comment:

Dragonfly said...

Good on you.