WhiteCoat

Not Heart Failure

I wasn’t giving in to the patient who wanted a prescription for Levaquin after the standard ZeePack didn’t cure his cough. He had a normal chest x-ray and labs the day before but was convinced that he had pneumonia. I tried explaining the difference between bacteria and viruses. I used the “RAID doesn’t work on dandelions” routine. He wasn’t convinced.

“I NEED a stronger antibiotic to break this up. Levaquin has worked in the past.”
“You know, I think I’m going to start you on some heart medications, instead. Some nitroglycerin and some Lasix for your heart failure.”
“Whaaat? I don’t have heart problems. I had a normal stress test a few months ago. Why would you want to start me on heart medications?”
“You have risk factors for heart problems and coughing is a sign of heart failure. I should probably start you on Digoxin, too. Ehhh … maybe not. That’s kind of strong medicine to start out with.”
“This is ridiculous. My chest x-ray and blood tests were normal yesterday. I don’t have heart failure. I’m calling my doctor and I’m not taking any of those medications.”
“Your chest x-ray was normal. That means you don’t have pneumonia, either. And bronchitis is a viral infection. Levaquin isn’t going to help your symptoms any more than the heart medications would. Do you see my point, now?”
[long pause]
“I’ll just call my doctor.”

I can only imagine what conversation sounded like.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

5 Responses to “Not Heart Failure”

  1. hashmd says:

    They will take only the portion of your conversation which will make you look like a complete and utter idiot, and tell EVERYONE within earshot. They will even go as far as say the chest X ray was positive for pneumonia!

    I’ve had parents of siblings tell me their child was diagnosed with Strep throat, only to look at the record and see that Urgent Care did the test and had a negative Rapid Strep (and the confirmatory culture was not back yet).

    • CJL says:

      I can’t tell you how many patients I’ve had who say they’ve had a heart attack (or several), and when I look back at the medical record, they’ve been seen in the ED for chest pain several times, and ruled out on every occasion.

      Makes you wonder how much (and what) patients actually hear when you talk to them.

  2. igloodoc says:

    Umm… WC… better get your response when you are summoned to the carpeted section ’cause your PG’s are down and the idio… um… prescient googleDR customer complained in a detailed type written single spaced 4 pager
    Better yet. Take Matt with you.

  3. Don says:

    Did you do a CAT scan of his brain because my uncle had a brain tumor and the only symptom was a persistent cough because the tumor triggered the cough reflex.

    Just kidding

    /not about the tumor, that was real, but the part of doing a CAT scan for everyone who has a cough

  4. therapydoc says:

    My husband is a family practitioner and he rants about this every single day (and never prescribes an antibiotic for me, naturally, and somehow I survive).

    I wish he’d just blog :)
    This one is great.

Leave a Reply


1 + = four

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM