Snow on the Mountains in Juarez

Middle of the night fun...

Let the test tell you the results, not the other way around

Just a reminder. When it comes to testing, walk through the door with an open mind. People with chronic illness often do a lot of research on their condition (or suspected conditon). We read the literature and we find symptoms that are eerily similar to our own. In doing this we start to develop presuppositions about what is going on with us. For many of us diagnosis is years in coming. And this time we are sure we know what had been going on in our bodies. We walk through the door just knowing what the test results will be. 

And then they are the opposite of our expectations. And we are angry and tired and heartbroken. We question our sanity, we question the competency of those working on our case, and it is easy to spiral into blame and bitterness. 

Please, learn to go into your testing with an open mind. After all, you don't want your symptoms to conform to a certain disease pattern. You want to find the disease pattern that causes your symptoms and fix it. Being diagnosed with a disease that you don't have may vindicate you, but in the end it doesn't help you improve your health or quality of life.

That being said, if you think your test was not preformed correctly or light have been influenced by some other factor, request that it be redone. Ask that your doctor revisit the dingosis.

http://www.cnn.com/2014/08/26/health/diseases-doctors-get-wrong/index.html

A higher standard.

So a common phrase muttered in the ER is "this is not burger king".
They are right; this is not burger king. As a patient you cannot walk up to the counter and order rocephin-burger with a side of prednisone for your (very likely viral) laryngitis. There are a lot of good reasons for this. 1. You don't need antibiotics, especially strong antibiotics for a viral infection. 2. Overuse of antibiotics has lead to superbugs that are bad for the community as a whole. 3. If your only symptom is that you can't talk, you will be just fine until Monday when you can follow up with your primary care provider.
But let's talk about us healthcare providers. We mutter in disgust when someone asks for something unreasonable, because it's annoying that people don't trust us with their health even after they have signed in and gotten the blood work. So here's the other side of the coin. This is NOT BURGER KING. We don't serve slabs of greasy beef between sesame seed buns. We have a standard to uphold. We have to give these people a reason to trust their health to us. If we mess up, someone could get really sick, their life could be seriously altered or they could die. For example, Walgreens has screwed around getting my prescription refilled for 6 days. They can't manage to figure out how to get my beta blocker, my SSRI or my whelcol refilled. (Beta blocker is a heart medicine that should not be suddenly changed or stopped, abruptly stopping an SSRI can cause suicide ideation and stopping my whelcol prevents me from eating anything for the last 6 days). I am very diligent with my medications to keep my body working to the best of it's ability. Being out of medications for almost a week is doing serious damage to me.
So, here's the deal. Next time you mutter that this is not burger king, take a look around and make sure you are running a 5 star restaurant.

Changing perceptions from the inside out

I want to address something that really irks me as both a medical professional and a patient with a rare disease.
So if you've read this, you know that I work at an ER. I've worked in the hospital, as a medical assistant and done some EMS work. We are trained to follow algorithms that indicate what is most likely to be wrong with our patient. The key words here are most likely. Yes, the old adage is usually correct. When you hear hoof-beats, think horses, not zebras. Most patients are horses, but that doesn't mean zebras don't exist. It takes a critical eye to catch the elusive zebra, but we are often so stuck on the flow chart that we miss these patients. They deserve to have someone think critically about their case.
In emergency medicine, the first glimpse of a patient we get is usually another persons notes. In EMS, we get our dispatchers notes, information they got from the caller. In the ER, we get triage notes, again another person's interpretation of the situation. It usually includes the persons age, sex and chief complaint. This initial assessment greatly influences the way we view the situation. A 19 year old female with chest pain is less of an emergency than a 67 year old male with chest pain. They may put the 19y/o down as a level 3 and the 67y/o as a level 1. 98% of the time, their assessment is dead on. The 67 year old is almost always more acute than a 19 year old.
Here is what I'm asking. Look closer. As much as I respect triage nurses and dispatchers, they can be wrong (so can I). Don't allow your mind to dismiss the 19 year old until you have looked at the vitals, the whole nurses note or laid eyes on the patient. Don't dismiss that patient and go to lunch because they will be fine until you get back (and I know about how hard it is to get a minute to eat, but you can ask the nurse how they are or poke your head in the room first).
Sometimes, the 67 year old, has a burning pain that began 10 days ago and is relieved by TUMS and the 19 year old has a connective tissue disorder and ripping pain with an acute onset an hour ago. We have all coded a young person and had no idea why they were in our ER. We need to learn to go into a patient encounter without presuppositions as to what is wrong with the patient, so we can catch the zebras. In the end, we are more than just a person following a flow chart.