WhiteCoat

Useless Workups

A patient calls his family doctor and gives a history of having chest pain on and off for the past few days. Pain worse with activity. Not having any now. Of course, you know that the family doc is going to send the patient to the Emergency Department. You just know it.

So the patient gets to the emergency department and of course the EKG is normal … and the labs are normal … and the chest x-ray is normal.

Because the patient has no history of chest pain workups, of course you know we have to recommend that the patient stay overnight and have a stress test in the morning.

“You’re kidding. I really have to stay? Everything is normal. Can’t I just go home and do it later? ”
“Well … no … not really. We can’t force you to stay in the hospital, but we really think that it would be a good idea.”

Then you start to second guess yourself. This guy’s in good health. He’s not having pain now. Of course the insurance company is going to call this an unnecessary admit.

Fortunately for everyone, you found a reason to justify the admission.

About 15 minutes later, the alarm goes off.

NSR to Torsades
Holy sh**! Torsades! Get the paddles!

It seemed like several minutes, but it ended up being more like 35 seconds until this happened.

Torsades Shock to NSR
“What happened?”
“Um. You nearly died.”

Had the patient not called his doctor, had the doctor not sent the patient to the hospital, had the patient not been brought right back and place on a monitor, or had the patient decided to leave AMA, he probably wouldn’t be here right now.

Triple vessel disease with a CABG.

Every once in a while those useless workups end up saving a life.

———————–

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.

9 Responses to “Useless Workups”

  1. Wayne Conrad says:

    This sounds a little familiar.

    My sweetheart was visiting her mother. Mom felt a bit off “off”. No pain, no definite symptoms, and if I were her, I would have brushed it off, but mom didn’t. Since her daughter was there, mom asked for a ride to the hospital “just to be safe.”

    The triage nurse found nothing remarkable, but they’d look at her when they could get past the urgent cases.

    Not long after, mom slumped over in her chair, arrested. Daughter yelled for help. They rushed her into a room, brought her back, and then sent her for a bypass.

    Straight out of a TV medical show, only without all the stupid sub-plots and unrealistic medicine.

    Daughter still shudders to think of what would have happened had she not been visiting.

  2. ndenunz says:

    I thought I knew where this story was going but was surprised at the end.

  3. hashmd says:

    This is why Whitecoat must keep a patient overnight. For the 20, 30, 40 that are negative, this is the one he saved. The stupid government, the regulators, the public, the insurance industry all wring their hands over the “unnecessary” workups and vilify the Dr. Whitecoats.

    But you damn well want Dr. WC to be the one you see if you take your spouse, your child, your parents to the E.D.! He will catch that 1 in 40, 1 in 80, 1 in 100 and save that life!

    That is why the government SHOULD NOT penalize a negative workup by only paying for positive findings. That is why it is unfair to label a negative workup as “unnecessary”. A doctor, a hospital, should be rewarded for being thorough, not for being perfect.

    Perfection is a goal, but should not be a mandate. Human beings can never be perfect. Why is it that doctors must be perfect?

  4. SeaSpray says:

    Wow!

    Thank God that worked out.

    I wonder about ekgs and stress tests because you can get normal results and drop dead the next day.

    I worked with a hospital staff person that happened to. Middle aged, just had a complete physical – labs, ekg, etc., 100% cleared and died in seconds of a massive MI that same week. Very sad.

    I recently read something about ekgs and stress tests aren’t the panacea patients think they are in terms of preventative health and that a stress test can reveal findings that may cause the patient to have to have more invasive procedures that may not have been necessary. I don’t know if that is true and first time I read that.

    Anyway …it’s not fair to financially penalize a doctor/hospital for keeping a pt for observation just because the person ends up alright. The whole point is no one knows that for sure.

    I wish these things weren’t so tricky and you could always get clear cut patient information. But ..I guess some things …only God knows.

    I wish everyone could have yearly body scans that could pinpoint exactly any possible trouble spots with accuracy (not false findings/incidental that would lead to erroneous invasive procedures)that really could help with preventative medicine.

    Again …only God can know for sure.

  5. Dee says:

    WOWZERS!!! I wasn’t quite expecting the end ECG strip!

    At least the guy was still there when this all happened. It sucks going anywhere (Dr’s office or ER) and not having your symptoms turn out to be anything, makes you feel like you’re a hypochondriac

  6. Aesop says:

    Strong work, Doc!

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