Me: How’re you doing today?
Patient: Oh, can’t complain.
Me: That’s good.
Patient: No one listens to me!
Me: Oh… well that’s not good.

I love patients with a sense of humor. Well, I hope my patient was just joking…

Some time ago I saw a patient that came into the clinic with a complaint of cough and congestion that had lasted for longer than the patient was comfortable with. I’ll call this patient, Gloria. Before seeing the patient, I spoke with the attending¹ regarding Gloria.

He asked me for my thoughts regarding the differential², but I didn’t really have a good answer. My first thought was that the symptoms were due to an infection. However, I was already told that this was not the most likely etiology for her symptoms for a couple of reasons: 1) symptoms started about a month ago, 2) blood pressure, temperature, respiratory rate were all within normal range 3) the chest x-ray came back normal, and 4) Gloria’s file showed that she had come in annually around the same time of the year with similar complaints.

At this point, the attending told me that the most likely cause of the symptoms was allergies. And, looking into Gloria’s file I saw that she had a history of allergic rhinitis³. Mentally, I chastised myself for not thinking of allergies. The attending, though, just moved on and ignored my ignorance.

The good thing about being a lowly 2nd year medical student attending clinic is the low expectations — expectations that you probably won’t even be held to. The doctors know that you are still just going through your basic sciences and know that your clinical knowledge/skills still have a ton of room for improvement.

I went to the waiting room, called Gloria inside, and walked her to the exam room. She explained that she had been congested for a month and also had a cough. Her symptoms had a seasonal pattern, occurring around the same time each year. They had also worsened in the days leading up to her clinic visit. This had coincided with the increased winds.

I proceeded to ask for specific symptoms. I asked Gloria about her eyes. I asked if she had any pain. I asked if there was a change in vision. I asked if she had any problems with her eyes. Each time I asked she said, “no.” And so I moved on to other organ systems.

When I finished the interview I listen to Gloria’s lungs. The lung fields were clear with normal breath sounds. Feeling pretty sure it was allergies (and not something more serious like a pneumonia), I left the patient in the exam room and waited for my attending so that we could discuss Gloria’s case.

After reporting my findings to the doctor, he asked if I had done a HEENT exam⁴. Sheepishly, I told him I hadn’t. Another thing had slipped my mind. He then asked if the patient had any problems with dry, itchy, red, and/or watery eyes since those are common with allergies.

I hadn’t thought about asking specifically, but I told him that I had asked the patient about eye problems in general, and more specifically, about pain and visual acuity changes. She told me she had no complaints about her eye.

Well a few minutes later when the attending pulled Gloria in to see her for himself, he asked her if she had experienced and itching or redness in her eyes. Her eyes lit up. “Why, yes,” she exclaimed.

And I, standing in the corner, shook my head — mentally. Physically, I just kind of looked straight ahead.

Sometimes patients just won’t give you the answers.

1. An attending physician is a doctor who as completed his or her residency. See here for more details. [↩]
2. I like to compare a differential diagnosis to a lineup of suspects that may be causing the patient’s complaint(s). Click here for Wikipedia entry. [↩]
3. Medline Plus: Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you breathe in something you are allergic to, such as dust, dander, or pollen. [↩]
4. Head, eyes, ears, nose & throat exam [↩]

One time I called a patient in from the waiting room, introduced myself as a medical student, and told the patient I would be taking him to see his doctor.

The patient nodded but then let out with this statement:

I refuse to go with you. I usually have some pretty girl take me.

 
So there’s that… At least I found out that I don’t look like a pretty girl…

Just found this music video on YouTube. It’s an a cappella group consisting of medical students at the University of Rochester School of Medicine.

Enjoy.

The patient shook his doctor’s hand in gratitude and said, “Since we are the best of friends, I would not want to insult you by offering payment. But I would like for you to know that I had mentioned you in my will.”

“That is very kind of you,” said the doctor emotionally, and then added, “Can I see that prescription I just gave you? I’d like to make a little change…”

Well I’m a fan of these medical student videos. So here’s another one. Enjoy.

I recently saw an episode of The Daily Show with Jon Stewart. It’s always an interesting way to get my news. But he did one segment which I’ve included below. Check it out.

I was gonna write about how surprised I am to hear that increased gambling was listed as a side-effect. But I figured that any way I found to convey my disbelief in such absurdity would kind of be overshadowed by Jon Stewart.

If anything, just remember to know what the side-effects are of any medication you take.

All of the videos I’ve shared on this site have been medical school related videos. This was created by nurses for a National Nurses’ Week Contest. Check it out, and enjoy.

The seven-year old girl told her mom, “A boy in my class asked me to play doctor.”

“Oh, dear,” the mother nervously sighed. “What happened, honey?”

“Nothing. He made me wait 45 minutes and then double-billed the insurance company.”

Things You Don’t Want to Hear a Surgeon Say in the Operating Room

• Oops!
• Has anyone seen my watch?
• Come back with that! Bad Dog!
• Wait a minute, if this is his spleen, then what’s that?
• Hand me that…uh…that uh…..thingy
• What do you mean he wasn’t in for a sex change!
• Damn, there go the lights again…
• Everybody stand back! I lost my contact lens!
• Well folks, this will be an experiment for all of us.
• What do you mean, he’s not insured?
• Let’s hurry, I don’t want to miss “American Idol”
• What do you mean “You want a divorce”!
• FIRE! FIRE! Everyone get out!