A mom comes to the emergency department at 5:00 AM with 4 children in tow. She wants to be evaluated for …

An insect bite to her neck.

Yes, the emergency was a mosquito bite about the size of a dime that was causing her to itch the side of her neck.

I looked at her, looked around the room to make sure that I wasn’t being Punk’d, then told her “Yup, it’s a mosquito bite.”
“What am I supposed to do?”
[Second look around the room, just to make sure I didn't miss any cameras.]
“Ummmm … put some ice on it. Maybe put some hydrocortisone cream on it. It will go away. Trust me.”
“I also want to be checked for diseases.”
“I don’t understand.”
“Mosquitoes have diseases and I want to be checked to make sure that I didn’t get any of them from this bite.”
[After a quick glance behind the door] “Which exact diseases would you like to be checked for?”
“I dunno, you’re the doctor.”
“Maybe that’s something you can take care of at the public health department when they open … in 4 or 5 hours. We don’t routinely do those tests in the emergency department.”

She left upset.

The best part of the interaction was a comment from the nursing supervisor after the patient left.

“You could have at least told her that she didn’t have encephalitis.”
“I could have told her she didn’t have any diseases, but I couldn’t prove it,” I replied.
“You could prove that she didn’t have encephalitis.”
“Not without doing a lumbar puncture or blood tests. Besides, nothing is going to show up that early, anyway.” I was too irritated to see that I was being set up.
He nodded his head smugly.
“OK, smart guy, how can you exclude an inoculation with encephalitis based solely on a clinical exam?”
“Simple anatomy. In order to have encephalitis, you have to have a brain.”

Oooh, you’re good.

I love my job.

This entry was posted on Wednesday, April 29th, 2009 at 6:30 am and is filed under Patient Encounters. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.