A Fool for a Patient

My Quora Answer to:
What was the most incorrect self-diagnosis you've encountered in your practice as a doctor?

My own. Any doctor who treats himself has a fool for a patient.

After my 5 muggings in Nicaragua over the Thanksgiving weekend in 2013, I developed a well-deserved diagnosis of PTSD. Which seemed to be fairly well-controlled until October 1, 2018. A few panic attacks here, occasional night terrors there, but I still maintained the ability to think and act rationally until then. And the next 6 weeks were pure Hell.

Mid November I finally came out of it. Here were my problems: hypersexuality, drinking, spending sprees, racing thoughts, weeks on end of “blacking out,” legal problems, and most distressful, loss of short term memory. I got on a bus 4 times to see my psychiatrist at the time, and 3 times I failed to get off the bus because I forgot where I was going. The 4th time was a disaster anyway because my psych couldn't see past the alcohol issue. I rarely, if ever, drink when I'm not psychotic, but her reply to my plea for help was, “go check into an ER.” That was the last time I saw her.

It wasn't until the first week in February that a more astute and compassionate doc diagnosed me with Bipolar Disorder. It was a bumpy road until then because I still believed (self-diagnosed) that the 6-week episode was PTSD. Once I got the correct diagnosis, everything fell into place. It was as if she shook a container of puzzle pieces and rolled out a finished masterpiece.

All is good now.

http://bit.ly/2Zv53uU

Scary Patients

My Quora Answer to:
As a doctor, have you ever been in danger from your patient?

Yes. Just one.

I was working in the ER at Waupun Hospital when the EMT's brought in a patient from a local prison. Waupun, Wisconsin is home to three prisons and close to a few others. The local economy thrives off of kidnapping and caging people.

Before I entered the bay, my nurse pulled me aside and warned me not to get close to the patient. He explained that the prisoner had permanently disabled a nurse at another hospital by attacking her physically during her intake exam. It was the only time in my career when I saw and treated a patient without doing a physical exam.

NB: I always did physical exams even with my psych patients. In addition, a physician can learn a lot just by observation. In medspeech, we document this with “A, A, Ox3, in NAD” which is shorthand for Awake, Alert, Oriented to person, place, and time, and in No Acute Distress. With ambulatory patients we also observe gait and lower body strength but the prisoner was shackled to a gurney and I was NOT going to unchain him just to observe his gait. That's how scared I was.

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