Least favorite chief complaint in your specialty

  1. Oh my gosh, “he is always sick, that’s not normal” for their perfectly healthy 7 year old, who I just watched eat a stray Cheerio off the ground. It’s also funny sometimes these concerns magically melt away when we offer to do some outpatient labs because the parent realizes they’ll have to hold their screaming kid down for a lab draw.

  2. I don't have any memories from before age 10 where my nose wasn't running or i had some bug. Never get sick now (except COVID twice ..)

  3. "I've run out of my little white tablet. No, I don't know what it's for, I don't know what dose it is, or how often I have it. It's just the little white one the doctor told me to take"

  4. Psych consult request for "history of depression". No active symptoms, not here for a psych related cause, not on any psych meds. Just patient- reported history that they have been sad at a point in their lives. Most of the time even the patient looks at me like "why tf are you here?"

  5. I recently got a consult for “too emotional” because the guy occasionally felt emotional and would tear up when playing sad songs (musician). Zero symptoms of depression, anxiety, anything. No inappropriate affect or anything. Just moved to tears by emotional songs he’d play.

  6. Oh god. I just got that on an 80something retired physician with cancer. He gave the medical student various increasingly implausible and alarming statements and then cracked up and said the primary team was a bunch of July idiots and please go away and leave him and his wife alone.

  7. My understanding is that screen time is associated with migraine but not non-migraine (e.g. chronic daily) headache. Thoughts?

  8. Reminds me of a patient I saw when I was a scribe. Long story short this like 12 year old girl had a panic attack when she had an argument with her mom, and he mom casually throws in they went to Starbucks on their way home. She let this 12 year old drink an entire large (or whatever it's called at Starbucks) coffee. No shit she had an anxiety attack.

  9. And of course, the dizziness is NEVER due to being 82 and being on 3mg of alprazolam daily, courtesy of the Jurassic doc who retired and dumped all of their patients on you.

  10. Once I started MRI’ing all dizzy patients who had risk factors or didn’t get better with meclizine fluids or a migraine cocktail I really relaxed on dizziness.

  11. EMS “Ya the nursing home called us for altered mentation. Their nurse said it was their first day with the patient and didn’t know the patients baseline, or meds, or history, or if there was a fall, or if their on blood thinners, or their code status. Also they didn’t send us with a med list or next of kin info. Patient has no complaints. Sugar was 150 vitals normal en route. Good luck doc!”

  12. Lololol I had an admission like that once. Pt came in from unknown nursing home, pleasantly demented, reported feeling fine when asked at ER, absolutely no paperwork from SNF, no prior record in chart. Easiest overnight admission I ever did. :)

  13. There was one time they were finally honest with me, possibly because I was rather friendly: "Can you guys take her, we just need a break."

  14. The amount of patients who tell me they died during a previous hospitalization seems to be way more than you would expect with the success rates of codes that make it to dc.

  15. Since having quite a few lectures with radiologists, I've learned to always put whatever it is I'm trying to figure out in my order. I don't think I've ever had a "ruq pain, looking for gallbladder pathology" result in anyone erroneously telling me that there's gallbladder disease.

  16. Ok but help me out here. I kept running into this exact scenario on metastatic spinal cord compression; neurosurgery wanted to know if the prognosis is >3 months to decide if they'd operate or recommend radiotherapy only. Searching the notes no prognosis is documented and a specific number was never given to the patient. How should I grok this??

  17. Oh god, and EVERY epistaxis patient will not stop blowing their fucking nose, or picking, or taking out the packing. I swear to god I want to put restraints on these fucking idiots. then they call you in to show you the blood clot they just blew out, and we start over. they are like toddlers.

  18. "Doc, I want my parent to be on comfort care measures...unless they get sick." Or the one I hate even more: "yeah, I want all the resuscitative measures unless they're not reasonable." Big guy, the choice to get intubated and sent to the ICU isn't one you get to unmake once you're anesthetized and on multiple pressors.

  19. Lol at the 'uno reverse card' for goals of care. So true! So tragically painful!!! Naturally in the ED nobody bothers to send the advance care directive the patient and family signed either, leading me to frantically guess and figure out what to do while someone is actively trying to die.

  20. Raisin on HD… haha thank you for laugh. I absolutely love hearing new lines that just fit so perfectly to the scenario

  21. Oh man I see this from the pharmacy perspective. We get a million calls from this patient during the transition period, “I’m getting a new doctor can you just fill some of my adderall until I see them? I can go without the others if I have to” like it’s a deal and I can give them 1 but not all of them

  22. Worsening memory on a patient who has been on QID Xanax for 10+ years plus ambien every night. Could not possibly be those meds or all the booze that the CDT indicates she is drinking...

  23. At my alma mater I was told a story about a pathology professor who after a long tenure finally got his portrait painted. Now, in this kind of portrait the surgeons were usually portrayed holding a scalpel. So, the pathology professor was asked what he wanted to be portrayed holding in his hands.

  24. Hahahaha I was going to put this but you got to it before me. Come on surgeons... You got 8 hours to do a surgery, you got 30 seconds to tell me why you did it!

  25. Lol I remember someone who called cause she needed help to go up the stairs. She insisted the fire department did it all the time, in their stair chair.

  26. Her doc isn’t there at 3am, and if she needs to see her doc specifically, then she can make an appointment. You called 911 because it’s supposed to be an emergency, so we are taking you to the closest hospital. If you want to go elsewhere, you can call a taxi or patient transport or drive her yourself. Smh

  27. Kid comes in with "horrible abdominal pain and constipation", parents convinced that it's a bowel obstruction. Parents feed them nothing but sugary drinks and cereal. Try to determine what brings them in today specifically and why to acute care. "Well, they complain often but now they haven't pooped in 4 days." Have they tried any dietary interventions for constipation? "Well yeah, we did, but they're never hungry when it's time for dinner." Did they consider that perhaps they're not hungry after having had cereal and such? "No cereal is not that filling and that is the one thing they will eat anyway, so we're not going to starve our child." What about drinking water? "Not sure about water, but they go through a couple of cans of coke a day..."

  28. This, plus actually convincing them it's constipation. "He poops every day, it can't be constipation! He even poops his pants sometimes and it's really liquidy!" Then I explain why that can actually be a sign of constipation and suggest a clean out. "I don't think that will work" ok then, how bout we get a completely unnecessary KUB to prove it? Oh look, it shows constipation. "I still don't think it's that. Can we just have a referral to the stomach doctor?"

  29. The number of people (adults and kids) who come to the ER for constipation and have tried exactly nothing for it blows my mind.

  30. I’m a nurse. Had a woman bring in her dad insisting that her sister was “drugging him” because she was giving him gabapentin. Nothing was wrong with him. She just insisted her sister was trying to kill him with gabapentin lolol

  31. The number of healthy Covid patients who come in with no real complaint besides "I don't feel good" and no risk factors makes me insane.

  32. The level of rage I have at this point for unvaccinated patients coming to the ED because they have COVID and are miserable is just incredible.

  33. Primary care — I get messages EVERY DAY from patients who are shocked and confused that it’s day 7 of COVID and they’re still coughing, usually asking for antibiotics/CXR or to come in and be seen. It’s confusing to me because in 2022 how can you have gone this long never knowing that COVID symptoms can last 2 weeks or longer?!

  34. Chest pain in a middle aged person with a handful of cardiovascular risk factors. You pretty much know from the beginning that the workup will be negative, but you have to do it because when one of these obese diabetic smokers drops dead from an MI 6 months later the family will be gunning for you. When the workup is negative patients are upset that you don't have a precise diagnosis. When the workup is positive the cardiologists are uniformly unconvinced (but still find time to cath the patient).

  35. Patient presents with request to refill a list of medications that look like a bad idea. Probably at least a couple of controlled prescriptions.

  36. When it comes to controlled substances I make sure to have extra staff +/- HP on standby because there's a non-zero chance they start threatening me when I say I'm not giving their benzo/stimulant/etc.

  37. I once had a patient with a history of a VP shunt who had just moved to our area from another state, and then when she was imaged for new symptoms, no shunt was present. Mom brought a bunch of records from the prior neurologist and neurosurgeon, and the MRI from a couple of years prior definitely showed a shunt. Mom swore that it was never removed and she had no idea why her daughter no longer had a shunt. I do not understand how some of these people just sign consent forms for BRAIN SURGERY without actually knowing what they are consenting to.

  38. This became actually easier as an attending compared to a resident. As a resident I use to spend an agonizing amount of time getting a good history and figuring out what’s going on.

  39. From an EMS perspective, these are my most interesting calls. It's like opening a box of chocolates and figuring out which one is the coconut. Dehydration? Hypoglycemia? Stroke? Cardiac? Psychological? All of the above? You get 3 minutes to figure it out: go.

  40. Tics in a patient whose parents insist on mentioning their history of multiple strep infections. This parent has gone down the PANDAS rabbit hole, it is very difficult to get them back out of it, and they hate my guts when I refuse to give their kid IVIG.

  41. As a Peds rheumatologist, PANDAS drive me crazy. I feel bad because they waited a while to see me and I have nothing for them.

  42. On the OB side, it was the “bleeding” that ultimately never filled a pad and 99% of the time was post coital and they “must get checked” so during the speculum exam, yup, just scant dark red blood and cum.

  43. Oh man. My mom insisted I have “my levels checked” when I work 50 hours a week, have 2 kids under the age of 5, taking classes, husband travels for work, and she wants me to take care of her.

  44. ID - "My naturopath/integrative medicine doctor sent me here so you could treat my Lyme disease/parasite infection/fungal infection."

  45. Or worse, they've been on some terrifying years long IV therapy for one of those, and no longer have bone marrow.

  46. "I've had this cough for 10 years, had millions of dollars of medical testing and seen three other pulmonologists, but now I'm here to see you."

  47. Easy one for me. 22 weeker and the parents want "everything done." The lines won't go in and if they do, the leg blanches. Then the kid gets a pulmonary hemorrhage just in time to save him from the grade 4 IVH which liquidates his brain.

  48. Psychiatry - medication side effects in a patient with a dozen "allergies" who absolutely cannot tolerate the 2.5mg of Lexapro I started them on a few days ago

  49. Pardon, but the pharmacy confirms that they have filled no prescriptions for you since our appointment. Whatever is wrong, it’s not the homeopathic SSRI you aren’t taking.

  50. As a floor nurse, I think you nailed it. And I work in peds. So it’s the overly concerned mom who doesn’t even know her kid smokes weed and her baby would never do that plus the vomiting that never ends despite around the clock meds.

  51. Consults: “I don’t know, I haven’t seen the patient yet. The overnight team said I should call this consult.”

  52. IM hospitalist - uncontrolled acute on chronic pain that is primarily functional in nature. That or uncontrolled N/V due to gastroparesis.

  53. When a dog (DVM) has diarrhea and the owner wants you to prescribe a pill to make it stop right away (but he’s pooping all over the house!!!!). And if it doesn’t they come back and complain and you eventually give them metronidazole even though studies have shown it doesn’t really work for diarrhea unless it’s Giardia. It’s sometimes giardia, but most often it’s the trash they found outside and they just need a few days to get over it! Hemorrhagic diarrhea is a different beast though (can cause extreme dehydration rapidly) and dogs are so prone to it so we always have to check it out (ie really hard to triage).

  54. There is a major communication barrier with character of pain when I speak with my Spanish speaking patients. It's always just "fuerte" (strong) and they look at me like I'm nuts when I ask "dull?sharp? achy?" Etc. 😆 "No, es fuerte".

  55. Hospitalist: weakness and/or dizziness in someone over 60. Fucking end me, it’s like a third of my admits. It’s the same non-critical benign workup. Admit for three midnights and dispo to SNF.

  56. I ran out of all of my meds and need them all refilled. In 20 min. 30 meds for like 12 conditions that are never monitored.

  57. Non compliant diabetics who call 911 because they binge ate junk food washed down with soda and now feel "funny" or "weird." They seldom check their own BG.

  58. Back pain in a young person with PACS absolutely chocked full of studies for “shoulder pain”, “abdominal pain”, brain MRIs for nonspecific numbness and headaches. Normal imaging, upset when they’re told surgery won’t help.

  59. I feel you. A lot of the conflicts that arise with patients seem to stem from the fact that they expect everything to be treatable. And in this case, I'm guessing, probably a refusal to recognize that they might be somatizing.

  60. "It may also be jet lag, I had just come back from a week long hike through Arizona, right after my camping trip to Rhode island"

  61. Malingering is probably my least favorite thing I see as an EEG tech. PNES and other lookalike symptoms of seizures I can handle, and have a lot of compassion for those patients. The people who are truly faking it to get something are the ones everyone else in the hospital remember and it affects the care of the next patient down the line who is non-epileptic but also not faking symptoms.

  62. I’ve spent the last week trying to convince MPOA of a 101 yr old to change to DNR as granny circles the drain… Nope. Full code, full interventions.

  63. Rads: follow up thyroid ultrasound w/ multiple nodules. The techs never measure anything the same or label the 6 nodules they find.

  64. POTS is the hot trend on the illfluencers tic tok. I'm not a member of tic tok but gently see if you can get out of them where they learned what they know about POTS. Is Munchhausen's by Internet a thing?

  65. When it's a legit one, the salt tabs, PO fluids, compression garments, and propranolol usually do the trick.

  66. Palpitations that are obviously psychosomatic. Followed closely by vasovagal syncope and POTS, but at least those come with some objective findings.

  67. As an ED nurse, it’s DKA. They’re always dry as shit so an IV is never easy. They can’t have anything to eat/drink, but are always the first to ask for something.

  68. The snack beggars kill me. I always give my DKA people all the water with the good crunchy ice their hearts desire, though. The ones that give you that look of complete relief when they get rid of that DKA thirst make my night.

  69. “You misunderstood. They said I can take care of your need for shoes. So, were we thinking bilateral BKA or AKA? The good news is I’m pretty sure I can keep it to transmetatarsal.”

  70. Very surprised no one has mentioned chronic abdominal pain yet. I start setting expectations in the first few minute that we'll rule out the scary stuff but likely won't find an answer. Add a side of cyclic nausea/vomiting and you have a real winner.

  71. Delirium. It's the sinus tachycardia of neurology. Rarely caused by a primary disorder of the brain, please look for the underlying non-neurologic cause, thanks.

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