Continuing with our ongoing series....this time. LISTENING to your patients.
Mr Smith (name altered) was a pleasant middle aged obese male who presented with a primary complaint of a sore throat. Triaged to Fast Track. Vitals demonstrated a normal temp, mildly hypertensive, normal pulse and respiratory rate. He appeared to be slightly disheveled, and his clothes looked to be stained and likely worn for several days. We discussed his sore throat, and the necessity for obtaining a strep test. He denied any associated nausea or vomiting, no body aches or chills, no fever, and no rash. He denied any change in the color of his urine. Exam showed some mild erythema in the posterior pharynx, and mild enlargement of his anterior cervical nodes. Otherwise the rest of the exam was unremarkable. AS I was finishing, his daughter enters the room. I explain my findings, and start to leave the room. I was about halfway through the door, when I hear the daughter say, "Dad, aren't you going to tell him about your urination problem". Feeling slightly annoyed, as I looked at the hallway full of blinking lights(New patients waiting), I turn back into the room. What urination problem I ask. The patient proceeds to tell me that for the past two months, he just has to go to the bathroom constantly. I ask him about any dribbling, urgency, etc.etc., and finally I ask him about his oral intake. His daughter starts to laugh, and says, well, "He's thirsty all the time. He's drinking soda constantly." Notwithstanding the sodium content in soda, I quickly order a BS. 1125 is the final diluted result from the lab. I order labs, urinalysis, and EKG, and then order the IV and initial Insulin protocol. I arrange to transfer him to the monitored area of our ER, and in order to help them, arrange for a bed and admit him prior to him going over there.
Just a little lesson on the importance of listening to your patient.