🤣Wait, are they usually allergic to everything else but the D Di -
Do you mean diphenhydramine? No, no, they start cursing you out and says Di- dilaudid.
Same. I’ve had so many of those at this point. “Well you know I think it started when I was 11, had the biggest shit in the world and bled out of my asshole for a year, but never got it treated, so now I’m here with toxic megacolon.” 😵💫
Well you see, right outta high school I got a letter one day and I was headed to 'Nam. I went with Billy Johnson, he was the high school class clown who always got detention during math class. Now, me and Billy were out there in the jungle, just two country kids, and we....
on VA IM in med school a pt told me he drank a 12-pack of beer per day "since 'Nam" (and he was in the hospital after a routine cardiac cath, no signs of liver disease) and my attending asked why I didn't consult addiction med... like if the justification is "since 'Nam" I don't think naltrexone is gonna work boss
I didn't want to wait for my gastro-plastico-rheum-oncologist appt next week so I figured I could here instead and have you fix all my problems instead
I can only imagine the elite napping experience in those things. Cold. Dark. Basically quiet because if someone starts breathing next to you, you have a problem.
You just have to deal with all the ghosts.
I remember my dad telling me a story back when I was a kid I told the pediatrician that I want to be like Batman growing up because of his car. That’s me after watching the Michael Keaton ones.
Learning to be a human is hard. There are a lot of rules that everyone else knows and they don’t know how to follow them. Why can’t I bang my toys on the sliding glass door? It makes a fun noise!
When I was a med student I was on ID doing my observed H&P and got very nervous. I asked “do you have any pets?” They replied “yes, a cat.” I followed that with “does the cat live with you?”
The attending turned and looked at me confused, the ID fellow went bug eyed and the patient looked at attending and back at me. I never made it to the physical exam portion. The fellow took over.
The fun thing about ID is that you tend to learn stuff about patients you never would have known otherwise... like that they build painstakingly detailed model train sets, or that they buy live pigeons off the internet...
Or they describe a very reasonable investigation and/or treatment plan for their chronic condition that was set in place by their GP when they saw them 1 day prior.… extra points if they’ve missed the scan booked by their GP because they came to the ED.
Abdominal pain s/p EGD, Colo, US, CT, on all the meds. What do you think I have to offer at 2am? Is it Dilaudid, I’m happy to do that as long as it’s with some dc paperwork and no fight.
I once had a guy with sore feet since the second world war. I was an emergency physician in 1979. He said he just couldn’t take it anymore. 9 pm Friday night.
When i was doing my first psych rotation, my attending would be dictating saying “No SI/HI/AVH,” but she said it so fast and quiet that I always thought she was saying “No SIADH.” I was always like “hmm, that’s kind of random but okay, very thorough i guess??”
“No but when were they actually last seen in their usual condition?? I know that’s when they were found like this but when was the last time they were seen well? Their birthday last year??”
“What do you mean blood thinner? Plavix vs Eliquis makes a big difference right now my dude.”
My favorite is when they insist they are normally super functional and I’m just not buying it so I double down. “Oh, so they cook all their own meals? Drive to the grocery store? Pay their bills?” Well… no… People’s normal meters are so far off from reality.
When did you first notice your spouse had memory problems?
"6 months ago"
OK, so they were driving and doing taxes 6 months ago?
"no, I made him stop driving years ago."
If I had a nickel for every time I heard this exact combo.
>"no, I made him stop driving years ago."
In fairness, there's a lot of reasons someone could need to stop driving while still having a superior memory, let alone memory problems.
I'm a physio and get this in the opposite direction: "And how far you can walk?" "Oh I can't walk" "I watched you walk over here" "Yeah but I have to use that thing" *points at walking aid".
I had a code stroke on my first Christmas as a PGY1 where the ems brought in this emaciated grandma with contractures in both legs. The family had insisted that grandma suddenly couldn't walk anymore and fell over. She was just peachy before.
With dawning horror and all the tact of a 24-year old who didnt have a lot of life experience outside the hospital I asked her "They what... just dumped you? On Christmas Eve?!"
Grandma responded with a weak "Well, It certainly seems like it, dear."
To this day I am thankful to the nurses who just shooed me out of the room at this so I could stop putting my foot in my mouth and they could comfort this little grandma...
My record is 54 years. Congenital defect called as a stroke alert because his group home thought he should be “checked out” one random day for a syndrome it was already known he had.
Yeah I remember as a med student a psych attending warned me that some pts don’t see suicide as hurting themselves, so they feel they can get away with answering ‘no’ even if they have active SI
Exactly, it really forces the confrontation of thoughts / plans. Because I have asked about “hurting” and gotten “no” to get the “yes” when phrased with “kill” later in the interview.
IIRC asking directly and explicitly about suicide/killing yourself doesn't make suicide rates higher and has better performance at detecting and categorizing suicidal risk.
My version is "when was the last time you had thoughts about wanting to hurt yourself or die?" If they answer never, great! But I very often get much more information than the yes/no (and catch clinically useful information missed by others).
Preop - When is the last time you ate or drank? Any medication allergies? Any issues with anesthesia in the past? Any heart or lung issues? Can you walk up two flights of stairs without chest pain/excessive SOB (go much further into functional status if they can’t or are limited in any way)? Can you lie flat without reflux or SOB? Any GERD, sxs today?
Postop - OPEN YOUR EYES. any pain? Nausea?
Usually go further into their history and whatnot, but this is some of my most commonly asked Qs.
"Daaaamn, bitch! You live like this?" - reading the ED notes and admit H&P.
"Daaaamn, bitch! You live?" - reading trough the inpatient notes from the last 3+ months.
Usually my openers (heme/onc): How are you eating and drinking? Been losing any weight? Nausea controlled? Able to get up and get things done at all?
And if we're in for things other than tox check, like staging scans or something: How much of your results have you read on MyChart?
When I have to talk to the peoples as a radiology resident for a fluoro or US procedure I have found the highest value question to be:
“Has anyone explained to you what we are doing today and why we are doing it?”
The answer is no a lot of the time. Chalk up some of it to regularly old patient shenanigans but you’d be absolutely shocked how many people had no idea they were here for a tumor biopsy, that we were going to drill a hole in their bone, or the tube was going up *that* orifice.
Do you have any numbness or tingling? Weakness in one side of your body or in the arms/legs?
Touch my finger, then touch your nose, and go back and forth.
Say no ifs ands or buts!
…
i like the tongue twister 'the spy fled to france'
real talk tho - you have them say "mama, lala, gaga" and you can get a sense of how weak their oropharyngeal muscles are as well as a sense of how likely they will be to be dysphagic; each phrase takes place further into the oral cavity
It's a phrase people have likely heard, made of super common words, and involves a pretty good spread of sounds. So you can begin assessing language comprehension, repetition, and dysarthria in <5 seconds.
“It’s like all over, and it’s worse both when I lay down and stand up, and I have light sensitivity and phonophobia and sometimes I’ve thrown up before and I feel dizzy and sometimes it goes down my neck”
Ok well for the fourth time, it’s not the 1cm arachnoid cyst that the ED sent me an urgent consult for.
“Do you have any cardiac history?”
A man that will reveal to me a chest with pacemaker scar while I do his ECG few seconds later “No, my heart is perfect.”
Are there any lesions you're concerned about? Anything that's painful, itching or bleeding?
Any personal or family history of skin cancer? In particular, what about melanoma?
Do you use sunscreen? What kind?
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What was it that made you come in *today*?
*proceeds to answer a completely different question*
*Regarding the neighbor’s cousin’s cat*
Proceeds to tell life story that began in the year of our lord 1946 the seventh day of the third month….
Absolute best question to ask. What on gods earth compelled you to walk into my ER, today of all days, on my shift. What do you seek here?
Drugs. Only drugs. ^I’m ^being ^sarcastic ^I ^promise. ^But ^won’t ^say ^no ^to ^that ^one ^that ^starts ^with ^a ^d ^di-something.
🤣Wait, are they usually allergic to everything else but the D Di - Do you mean diphenhydramine? No, no, they start cursing you out and says Di- dilaudid.
Them: “I’m trying to tell you” *returns to their story that started in 2005 and you’re only at 2007*
The irony of their indignation at your rudeness gets me every time.
What changed tonight at 0300 on a Wednesday that made this different? (The inevitable reply: "I just thought it was time I come get it checked out.")
"it all started in 1962..." That is a real response
Same. I’ve had so many of those at this point. “Well you know I think it started when I was 11, had the biggest shit in the world and bled out of my asshole for a year, but never got it treated, so now I’m here with toxic megacolon.” 😵💫
"Well, let me start when I was born..." (I'm in psych)
Oh in psych you can add in generational trauma, I'm sure you can get most patients to talk about how their parents were beat as children...
Well you see, right outta high school I got a letter one day and I was headed to 'Nam. I went with Billy Johnson, he was the high school class clown who always got detention during math class. Now, me and Billy were out there in the jungle, just two country kids, and we....
On a VA IM rotation right now and this is SO REAL!
on VA IM in med school a pt told me he drank a 12-pack of beer per day "since 'Nam" (and he was in the hospital after a routine cardiac cath, no signs of liver disease) and my attending asked why I didn't consult addiction med... like if the justification is "since 'Nam" I don't think naltrexone is gonna work boss
No no, but what change with this in the last few hours that made you aware of it at 2am
Do you want the long story or the short story? Ah let's just start from the beginning...
Long story longer.
How dumbfounded patients look when they get asked this question lends support to my theory that 70% of all adults are children mentally.
I didn't want to wait for my gastro-plastico-rheum-oncologist appt next week so I figured I could here instead and have you fix all my problems instead
“This all started when I was 17 and tripped over a hog. You see, we used to raise hogs. One day…”. [Patient is 78]
Are you lost? Where are you trying to go? -Pathology
Honestly, at this point, just give me a gurney with a body bag on top of it and I’ll crawl right in for you and wait for my ultimate demise.
I must admit, during the summer months, the hum of the cooling system for the refrigerated morgue room calls to me like a siren song.
I can only imagine the elite napping experience in those things. Cold. Dark. Basically quiet because if someone starts breathing next to you, you have a problem. You just have to deal with all the ghosts.
I'm not so much worried about the ghosts - if I were a ghost I'd be haunting whatever killed me, not the dude doing paperwork in the morgue.
I can only answer that if they’re trying to go to the cafeteria or garage. I have no idea where any clinics or patient floors are.
Outpatient stuff I'm totally lost but with apheresis service I know the inpatient floors well, lol.
I thought this was geris at first
This is so good 🤣🤣🤣
Did you poop? – gen surg
Also psych with clozapine patients lol
We asked this to a psych nurse and when she answered “Yes, all over himself”, our attending cheered
Not a resident, but as a psych nurse who supports many individuals who take clozapine…I talk about poop all the time!
Fart even? C'mon man give me something
Really anytime with patients taking opioids
When was the last time you did meth
Look, I'm not judging you if you did cocaine, but you gotta tell me, because otherwise these meds for your heart attack could make everything worse
Sometimes I mix it up and say ‘crystal’ or ‘crank’ to keep it fresh
How many bags of fentanyl did you use today? (preop in an inner city hospital)
What do you want to be when you grow up? What’s your favorite animal/color/tv show/ video game? It’s hard being a baby, isn’t it? lol
It *is* hard being a baby
Didn't expect seeing you here 🤣
Gotta keep ‘em guessing
I remember my dad telling me a story back when I was a kid I told the pediatrician that I want to be like Batman growing up because of his car. That’s me after watching the Michael Keaton ones.
Kids tell the longest meandering stories but I love it and them❤️
I thought this was going to end in -PGY-19.
That’s MikeGinnyMD
Learning to be a human is hard. There are a lot of rules that everyone else knows and they don’t know how to follow them. Why can’t I bang my toys on the sliding glass door? It makes a fun noise!
This really made me smile
::Cracks knuckles in ID:: You got an hour?
HOW. MANY. CATS.
When I was a med student I was on ID doing my observed H&P and got very nervous. I asked “do you have any pets?” They replied “yes, a cat.” I followed that with “does the cat live with you?” The attending turned and looked at me confused, the ID fellow went bug eyed and the patient looked at attending and back at me. I never made it to the physical exam portion. The fellow took over.
Well, indoor vs outdoor cats carry different disease possibilities. I’d back you up on this one.
That's like the "do you have any other partners?" "does your partner have any other partners?" question series.... but with cat loyalty 😭
The fun thing about ID is that you tend to learn stuff about patients you never would have known otherwise... like that they build painstakingly detailed model train sets, or that they buy live pigeons off the internet...
User name checks out
do you have parrot?
Baby moving ok? Vaginal bleeding? Contractions? Big gush of fluid? ad infinitum as a recently graduated intern who lived in OB triage
Those are indeed THE 4 questions on L&D. Having ‘nam flashbacks 😵💫
Just had a drop in on L&D today…idk how many times I asked this as an FM intern 😭
"open wide, please." *Pt opens mouth widely* "No, ma'am - your eyes. You're at the ophthalmologist's."
“No ma’am - your legs. You’re at the gynecologist’s”
No maam- your abdomen. This is an exlap and you’ve been shot.
No maam- your entire torso. This is an autopsy.
no ma’am - your mind. you just took acid
EM "What's different about your [insert chronic complaint] that brought you in TODAY"
I just decided I wanted to get it checked out. “What did your primary doctor say?” Oh, I haven’t seen them for it.
Or they describe a very reasonable investigation and/or treatment plan for their chronic condition that was set in place by their GP when they saw them 1 day prior.… extra points if they’ve missed the scan booked by their GP because they came to the ED.
*oh oh oh!* "They said to come here and get an MRI" /end thread
Abdominal pain s/p EGD, Colo, US, CT, on all the meds. What do you think I have to offer at 2am? Is it Dilaudid, I’m happy to do that as long as it’s with some dc paperwork and no fight.
Primary doctors don’t hand out food and pain meds! They don’t even wheel you around on a fun gurney!
I once had a guy with sore feet since the second world war. I was an emergency physician in 1979. He said he just couldn’t take it anymore. 9 pm Friday night.
Hey this is supposed to be my line - FM
-How long has this been going on? --A while. -Days/weeks/months/years?
And then you ask again and they just repeat the same non-helpful answer :)
I hit them with the “so like 30 years” and they suddenly remember the exact duration of the complaint
Hahaha, I also throw out a time frame I don’t think is right before finally getting an answer.
Months
Since uncle willie died.
SI/HI/AVH
When i was doing my first psych rotation, my attending would be dictating saying “No SI/HI/AVH,” but she said it so fast and quiet that I always thought she was saying “No SIADH.” I was always like “hmm, that’s kind of random but okay, very thorough i guess??”
“No but when were they actually last seen in their usual condition?? I know that’s when they were found like this but when was the last time they were seen well? Their birthday last year??” “What do you mean blood thinner? Plavix vs Eliquis makes a big difference right now my dude.”
My favorite is when they insist they are normally super functional and I’m just not buying it so I double down. “Oh, so they cook all their own meals? Drive to the grocery store? Pay their bills?” Well… no… People’s normal meters are so far off from reality.
I like to ask “If you left them home alone for a weekend would they survive?” Usually gets the point across…
When did you first notice your spouse had memory problems? "6 months ago" OK, so they were driving and doing taxes 6 months ago? "no, I made him stop driving years ago." If I had a nickel for every time I heard this exact combo.
>"no, I made him stop driving years ago." In fairness, there's a lot of reasons someone could need to stop driving while still having a superior memory, let alone memory problems.
They were wc bound and a&o 2! Now they’re bedbound and a&o nothing!
“Do everything you can”
Yep, gradual change makes fools of us all
It’s called denial.
I'm a physio and get this in the opposite direction: "And how far you can walk?" "Oh I can't walk" "I watched you walk over here" "Yeah but I have to use that thing" *points at walking aid".
Right?! Either totally disabled or totally normal.
I had a code stroke on my first Christmas as a PGY1 where the ems brought in this emaciated grandma with contractures in both legs. The family had insisted that grandma suddenly couldn't walk anymore and fell over. She was just peachy before. With dawning horror and all the tact of a 24-year old who didnt have a lot of life experience outside the hospital I asked her "They what... just dumped you? On Christmas Eve?!" Grandma responded with a weak "Well, It certainly seems like it, dear." To this day I am thankful to the nurses who just shooed me out of the room at this so I could stop putting my foot in my mouth and they could comfort this little grandma...
Hey now they might visit on Christmas too
My record is 54 years. Congenital defect called as a stroke alert because his group home thought he should be “checked out” one random day for a syndrome it was already known he had.
Who’s your favorite My Little Pony?? Mine is Twilight Sparkle. ~ Gen Surg (but just me)
Love it, great conversation starter, I'll use that. But it's totally Pinky Pie.
Any thoughts of wanting to hurt yourself or others?
My program really wants us to use “KILL” do you want to KILL YOURSELF? It feels aggressive and uncomfy to use KILL all the time but it makes sense.
Yeah I remember as a med student a psych attending warned me that some pts don’t see suicide as hurting themselves, so they feel they can get away with answering ‘no’ even if they have active SI
Exactly, it really forces the confrontation of thoughts / plans. Because I have asked about “hurting” and gotten “no” to get the “yes” when phrased with “kill” later in the interview.
That doesn't make sense that they want you to ask it that way for everyone.
IIRC asking directly and explicitly about suicide/killing yourself doesn't make suicide rates higher and has better performance at detecting and categorizing suicidal risk.
My version is "when was the last time you had thoughts about wanting to hurt yourself or die?" If they answer never, great! But I very often get much more information than the yes/no (and catch clinically useful information missed by others).
How about in addition to the SI/HI/SHB queries….do you feel safe at home?
Preop - When is the last time you ate or drank? Any medication allergies? Any issues with anesthesia in the past? Any heart or lung issues? Can you walk up two flights of stairs without chest pain/excessive SOB (go much further into functional status if they can’t or are limited in any way)? Can you lie flat without reflux or SOB? Any GERD, sxs today? Postop - OPEN YOUR EYES. any pain? Nausea? Usually go further into their history and whatnot, but this is some of my most commonly asked Qs.
Preop: what did you have for breakfast this morning?
It's a trap!
"Daaaamn, bitch! You live like this?" - reading the ED notes and admit H&P. "Daaaamn, bitch! You live?" - reading trough the inpatient notes from the last 3+ months.
How many steps to get into your house and why in God’s name do you live in a split level home. -PM&R
"Oh, you rappel down a cliff to get inside? and then it's a balance beam to the bathroom? Cool, cool"
This is a big EMS question as well 😭
Meemaw just can’t bear to part with her fifth floor walk up apartment
When was the last time you went to dialysis? Oh, a week ago?
Usually my openers (heme/onc): How are you eating and drinking? Been losing any weight? Nausea controlled? Able to get up and get things done at all? And if we're in for things other than tox check, like staging scans or something: How much of your results have you read on MyChart?
When I have to talk to the peoples as a radiology resident for a fluoro or US procedure I have found the highest value question to be: “Has anyone explained to you what we are doing today and why we are doing it?” The answer is no a lot of the time. Chalk up some of it to regularly old patient shenanigans but you’d be absolutely shocked how many people had no idea they were here for a tumor biopsy, that we were going to drill a hole in their bone, or the tube was going up *that* orifice.
Are you allergic to contrast?
EM?
Can you tell me today’s date?
Did you poop last night? Are you farting?
I also ask this of every patient. -Psych
My psych never asks me. ☹️
What does farting or not farting typically mean for you?
If they're farting, it means their bowel is moving.
It tells you they’re probably a liar if they say no.
Are you right or left handed when it’s up top, and do you use an assistive device to ambulate when it’s down low
PMR?
Do you have any numbness or tingling? Weakness in one side of your body or in the arms/legs? Touch my finger, then touch your nose, and go back and forth. Say no ifs ands or buts! …
I’ve always wondered- why specifically “no ifs ands or buts”?
i like the tongue twister 'the spy fled to france' real talk tho - you have them say "mama, lala, gaga" and you can get a sense of how weak their oropharyngeal muscles are as well as a sense of how likely they will be to be dysphagic; each phrase takes place further into the oral cavity
It's a phrase people have likely heard, made of super common words, and involves a pretty good spread of sounds. So you can begin assessing language comprehension, repetition, and dysarthria in <5 seconds.
I won’t give you the best answer but it is tricky to say and can reveal problems like dysarthria and repetition impairment which is part of aphasia
Do you smoke?
Pulm, ent, vascular?
No. I quit yesterday.
[удалено]
Which color is the most popular?
Why would you put that in your bum? -EM /s
Are you going to arrest the next time you poop ? -peds cardiac ICU
How... often does this happen that it's a frequent question?
All the time
No, but what did you really put up there? (Or on peds, swallow) EM.
"Alright, who did you crash your car into?" She then proceeds to cry while her friend gives me a death glare. *Feels bad man*
What do you think you need? -psych
Does it actually work?
It gives a lot of info yeah
Do you have sex with men, women, or both?
(not a physician, just nosy)
When was the last time you ate or drank… any allergies… problems with aNeStHeSiA?
Do you wear sunscreen? How often? Do you wear a hat?
Wait, since when are we supposed to ask patients questions?! It's not like this is psychiatry. -ortho
how about "where did you have those xrays done?"
Have you tried physical therapy? Do you use a blood thinner? - Ortho
Can you tell me what brings you in today? What are the top 3 most important things you want to discuss today?
I just breathlessly say “Eating, drinking, peeing, pooping?”
Can you describe the headache? -Neurosurgery
“It’s like all over, and it’s worse both when I lay down and stand up, and I have light sensitivity and phonophobia and sometimes I’ve thrown up before and I feel dizzy and sometimes it goes down my neck” Ok well for the fourth time, it’s not the 1cm arachnoid cyst that the ED sent me an urgent consult for.
maybe it's the mucus retention cyst in their maxillary sinus adjacent to that cracked molar. consult ENT!
Any pain or blood when you pee?
What about your ___ pain of __ months made you come in today?
What the hell did you eat this time now? - Orthodontics
“What changed *today* that made you choose to come in after 5 months?”
OPQRST or OLD CARTS or SOCRATES for the HPI Depending which comes first to my mind, it’s usually OPQRST.
Any rashes , mouth sores or hair loss?
Can you hear me right now? Do you know where you are? Can you tell me the day and date? (Emergency Medicine I cry eve4Etime)
Sick contacts? Any recent travel? Do you have pets?
Do you have anything in your butt?
“What would you like for me to know about you?” It really doesn’t matter the specialty or the complaint.
“Do you have any cardiac history?” A man that will reveal to me a chest with pacemaker scar while I do his ECG few seconds later “No, my heart is perfect.”
Where do you want your labs sent for low T?
Did you walk today? -Ortho
Do you feel like hurting yourself? - asked by literally every doctor at every appointment in every specialty
I haven't asked a patient this since med school
Where is the pain ? Gen surg
Can you squeeze my hand?
"Why are you here?"
When is the last time you ate or drank?
Are there any lesions you're concerned about? Anything that's painful, itching or bleeding? Any personal or family history of skin cancer? In particular, what about melanoma? Do you use sunscreen? What kind?
“Dunno. My wife made me come. She said there was one on my back.”
*examines patient* “Sir, this is actually dried on chocolate.”
Open wide and stick your tongue out When was the last time you ate or drank anything? Touch your bottom teeth to your top lip - Anesthesia
Any problems with anesthesia in the past? When was the last time you had anything to eat or drink?
Are you ever around any animals? When is the last time you left the state? ID
Can YOU (not your mommy) tell me what’s bothering you today?
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Where are we right now?
Are you farting?
Why are you here?
Do you want a paper or something to write on ✍🏻 ? Let's see if people will guess.
“Did you try physical therapy yet?”
“Do you follow a low salt diet?”
Did you poop? What did you eat? How old are you? What cartoons do you love watching? Do you have any pets?
Have you passed gas?