Doctors are teachers too

Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room. The man who felt bad all over had a bilirubin twice the upper limit, his liver enzymes were elevated and although he didn’t have a fever, his white blood cell count was elevated. I explained to him and his wife that his bile ducts were plugged and he was being poisoned from inside by all that bile and there may even be a brewing infection in his gallbladder. The ambulance had just come back from the hospital, and after they loaded him on the rig, I called the emergency room again and said “I’ve got another one for you”. The neurosurgeon on duty returned my call just after five. He was able to look at the MRI images as I told him about the patient’s physical exam and his two-week history of back pain with sudden urges to urinate or defecate (which in my office note had been transcribed as “deprecate” by the voice recognition software). He told me to have the patient call his office Tuesday morning, and they’d get him into the Wednesday neurosurgery clinic. I called the patient and told him the news. He was feeling quite a bit better on the prednisone I had prescribed. I explained what the MRI report said about how tight his spinal canal and the exit holes...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs