A physician ’s personal crisis with pain

Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much worse. Ten days later, I returned to the ER. I was given ketorolac and had a CT, which showed no stone. The ER attending advised me to go home and take ibuprofen. At that point, my pain was 8/10, and I was having significant trouble moving despite the ketorolac. I felt like my physician saw me as a drug seeker, rather than a fellow attending. I had already tried strong NSAIDs, and I remained in unrelenting pain. But my pain didn’t fit a clinical picture — I had no abnormal imaging, so I was discharged with no diagnosis and no treatment plan. Once a stone was ruled out, the attending didn’t widen his search. He never did more than a 30-second exam. Clearly, I knew something was wrong. I just didn’t know what. I’ve concluded ERs are places to rule out life-threatening issues. I was in severe pain, but I wasn’t dying. So, I was discharged. As a clinician, it was a good lesson in how not to work up an undifferentiated problem. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Emergency Medicine Nephrology Pain Management Source Type: blogs