CHAPTER 10 – A 26 YEAR OLD WOMAN WITH WEAKNESS AND FALLS:
A ROUGH LIFE WITH A TOUGH PROGNOSIS
And for the last case – in some ways the toughest and in others, the easiest. I will say this, I have had this patient, poor social situation, some physician challenges, unilateral weakness or numbness, and have done the stroke workup and come up with a big fat nothing! That being said, how many chest pain patients do we see and admit to find one MI? What is your acceptable miss rate?
Sometimes these cases are about more than one missed opportunity; this case had almost too many to count (won’t go through them again here). Which is exactly where bias may emerge, a patient who is demanding or noncompliant (doesn’t want an IV or Tylenol…) does not endear herself to the ED staff. We want her out of there yesterday, exactly where a mistake may be made.
Was the panic attack patient perseverating on their physical complaints, was the schizophrenic on crack yelling at the security officers, did the drug seeker lie to you? Of course, they did… they are a drug seeker!
It is hard to separate our feelings from our care, but essential with just this type of patient.
- If you are a doctor, do you read all the charts of patients seen by the MLP’s?
- If you are a MLP, do you discuss all your patients with the physician?
- If you are a patient, who is in charge of your care?