Friday, January 9, 2009

Funny Patient Encounter

SO, I am working not long ago, and have a middle aged female present with chronic LLE pain, I am completely slammed and have 8 patients in my hallway. She states that she has had numerous visits with her primary care, as well as a PM&R doc and an orthopedist regarding this pain which has persisted for 8 weeks.

Me: So this pain has persisted for 8 weeks, correct?

Patient: Yes...

Me: So what has changed today, what made you present to the ER?

Patient: well, the pain is still there, duh

Me: But the pain has been there for 8 weeks, correct?

Patient: yeah

Me: so what changed?

Patient: I don't understand.

Me: that's okay.

Patient: Aren't you going to fix it?

Me: Fix what?

Patient: whatever is causing my pain?

Me: You will likely need a more extensive workup in the clinic setting ma'am.

Patient: But can't you operate on it?

Me: On what?

Patient: My back or leg, or whatever is causing my pain.

Me: Right here?

Patient: yeah.

Me: Ma'am, I'm trying to understand what has changed in your pain pattern, so that I can better understand why you are here, and what might be going on.

Patient: Well, nothing has changed, and I want answers.

Me: So the pain is the same.

Patient: Yeah, but I'm tired of it.

Me: Well, I need to be honest with you, we might be able to offer slightly better pain management, but you've had an extensive workup, and we will likely not find out what is causing your pain tonight in the ER.

Patient: Why not?

Me: Because this is a complex problem, and the symptoms you are describing sound neuropathic in nature. You have also had multiple imaging studies and visits elsewhere, with negative findings so far.

Patient: I don't understand.

Me: Ma'am, we will provide better pain management and a follow up with our primary care clinic. Unfortunately, at this hour (10pm) this is the best I can offer you now.

For the record, she was pain free upon presentation. Her pain was a burning, "shooting" pain down her leg that only occured sporadically. She had no loss of bladder or bowel control, and no weakness or loss of sensation on exam. Long tract signs were negative. Negative SLR, No spinal midline tenderness.


The Happy Hospitalist said...

I have this exact same conversation on a daily basis.

Anonymous said...

"and I still can't go back to work"

Jessica Kirkland said...

haha. that is actually a pretty funny story. Sounds similar to some conversations I have with my 3 year old triplets.