I know what you’re thinking about - it was focused around med students and residents, I believe.
Ah hah - I started Googling and then remembered the thread title: “Things I learn from my patients.” The link is at studentdoctor.net but that site appears to be down at this moment.
I spent most of my clinical career as an Emergency Physician, and my boards are in both Internal Medicine and Emergency Medicine. So between the two I’ve got a boatload of potentially lethal conditions presenting with minimal symptoms in a handful of the hundred thousand or so patients I’ve treated over my career.
There is no sign or symptom that cannot be the initial harbinger of doom. A previously unnoticed “freckle” can be the presenting sign for meningococcemia or acute leukemia. Hiccups? Phrenic nerve irritation from lung cancer. You get the idea. New medical students learning about all the various presentations for illnesses are the worst for diagnosing disaster based on trivial signs and symptoms. They occasionally embarrass us by being right, but as KarlGauss points out above, the real trick is not working up every molehill for the mountain it may be.
ALS. That’s how my mom died. And it started with a cough and rough throat that wouldn’t go away. Gradually she lost the ability to command her muscles, and they began to atrophy. Eventually she couldn’t move, and one day she went to sleep on the couch in front of the TV next to my stepfather and only he woke up.
9 years ago last April when he was 43 years old, my dad got a sudden, very severe headache. It was slightly different from his lifelong migraines in that he felt a ‘pop’ at the back of his head, and a sensation of spreading pain and coldness across his skull. ‘Like someone cracked an egg on the back of my head’, he told me. He spent two days in bed. Usually his migraines only lasted part of a day.
From his doctor’s best guess, this is when his super-giant fusiform cerebral aneurysm sprung a leak.
He felt better, although he had a fairly typical migraine ‘hangover’ involving some impairments for days following, and the next week was interviewing for a job he really wanted when the whole thing went kablooey. He lapsed into a coma mid-sentence with his eyes open. His interviewer called an ambulance right away and the people in the office saved his life by providing mouth-to-mouth because he stopped breathing. He was in the ER within 20 minutes, and he was airlifted and in surgery within two hours. Very long story, full of near-death experiences, short: he has had a recovery that all his doctors have called ‘miraculous’ but it’s been very slow and he will always be profoundly affected. About a third of his brain died.
Moral: don’t feel stupid going to the ER when you have a terrible headache with any usual symptoms (or even if you head just hurts very badly!). My father’s surgeon described ruptured brain aneurysms as ‘the worst headache you ever had in your life, or almost instant death’. Brain aneuryms are highly hereditary and more common in women, so this is advice I will be living by.
I just wanted to add that what may seem to be a trivial symptom to the average man in the street may be perceived as very serious by a doctor.
For example- infants under 3 months should never have fevers of 38C (100.4F) or above. If your newborn has a fever they need urgent medical attention pronto (and a chest X-ray, lumbar puncture, urine screen and blood tests), not a cool bath and some baby Tylenol.
See, if you walked into my ER and told me that, I would have hustled you back into a bed and been tugging on my doctors coat to order a CT scan right fuckin’ now.
I think about that all the time outlierrn. If he had gone to the hospital when that happened, it’s possible he would have been in emergency surgery that day, and might had ended up with no brain damage at all.
This is what happened to my cousin. He was fifteen and completely healthy. One night he complained of a slight headache, so he took a couple of Tylenol and went to bed early. When my uncle went to his room to make sure he was up the next morning, he found my cousin sprawled across the floor–he had obviously attempted to get out of bed and collapsed. He never regained consciousness. His twin sister said later she thought she might have heard him get up in the middle of the night to throw up, but she was only half awake and wasn’t sure. They took him off life support about 24 hours later, after getting the organ donation ducks in a row.
Fucking sucks to lose someone that way.
Hey, I didn’t mean to suggest that you should have known that, or it was in any way your fault. There are just some keywords in your post that are suggestive of a vascular event to a long time ER nurse, like me.
A case where a headache is apparently likely to mean blood in the brain (sorry, can’t remember the medical term) is when a woman has recently had a very energetic delivery (not difficult as in the kid was in the right position and everything, no medical problems per se, but it was a big kid).
A childhood friend of mine had been sent to the trauma floor after her delivery because the beds in the ObGyn floor were all occupied. After the nurses there treated her growing headaches with ever-growing doses of aspirin, the bereaved relatives asked, as part of the compensation package, that the Hospital intensify cross-specialty training (the Hospital is also paying for the daughter’s schooling up to and including PhD, as well as other financial compensation). It wasn’t a huge emergency initially, but it should have been watched and it should have been treated with a completely different set of drugs.
MS is not a life-or-death emergency, but the list of symptoms is ridiculously mundane, and sometimes contradictory. “Has problems remembering words” (during an attack), “lowered libido” (again during an attack… heck, I get lowered libido from having a cold), “diarrhea”, “constipation”, etc.
Probably from here. The Student Doctor Network has been linked here a couple of times. You’re probably thinking of Things I Learn from my Patients and Medicine Sucks
FWIW, as X-ray Tech with heavy ER/Trauma experience, I would’ve been running that stretcher outlierrn had placed patient upon to the ‘scanner’, even without a Doc’s order (if Doc was not right there to speak with, per se). That’s just because education/experience tells me (outlierrn, too!) that there’s an issue of utmost urgency. ‘Average layman’ could easily not know such. And in general isn’t expected to as there’s just so much variance and inter-relations of ‘little benign things’ that are tapping a person on their shoulder and saying ‘hey, how’s it going, buddy?’.
The saying “Ignorance is bliss” rings true so often (unfortunately, but that’s Life, 'eh? aka ‘Feces occur’). I do hope that folks that have had bad events and/or death to loved-one(s) not dwell on the “If I had done something sooner, so-and-so would certainly be alive”. Not any fault to assign in most cases, imho - but at times, us ‘pros’ have to think to ourselves “WTF? Really, WTF were they thinking?!?!”. Not gonna say it to their face, but often makes ‘us’ wonder about some folks :eek: rhubarbarin, ain’t speaking of you at all, fwiw, not in any manner (!). I’m looking towards the folks themselves that have the seriously-unusual symptoms and lay around for days and days. And practically beat-down their spouse to inaction as spouse tried dragging their ass to car, or snatch phone from hand as they try to call ambulance out of concern/love. Those kind of persons that will tell us that it did not seem to be any big deal even though they couldn’t get to car themselves. Result: spouse is widow or has a now-invalid spouse that needs diaper-changing every few hours and only books of interest are coloring books with one crayon of any color being all that is needed to keep ‘em happy. At times, its kind of funny (and highly satisfying, imho) overhearing an old-lady ripping the old-man a new one, so to speak, for ignoring her - not unknown for the ~ER folks to gather close(r) to listen in a bit with it being so entertaining. The old-ladies generally don’t bother to whisper their "Told ya so, ya ol’ coot!" words. No, its practically over the PA-system sometimes. Compliance of ‘deniers’ almost as-a-rule goes way, way, waaaaay up after such ‘lectures’ 
Moral: do not piss-off the person that you will likely be depending upon for ~‘wiping your ass’ if you become unable to do so from dutifully ignoring screaming-at-you symptoms.
Oh, I didn’t think anyone was implying there was something I should have done. I don’t blame myself in the least, I was only 15 years old, what did I know about what merited a visit to the emergency room?
It’s just so sad to be able to have hindsight and to realize the event that so totally changed my father and my family forever could have been prevented. If my father would have realized that pain that severe was a serious problem and overcome his martyr tendencies, or my mother would have insisted it was better safe than sorry… He had good health insurance at the time (thank goodness considering what happened next), there was no good reason for him not to have gone in. But like many men, he seemed to avoid medical treatment whenever possible.
A fifty six year old man goes out to his workplace, he is remarkably fit for his age, walks long distances in the woods frequently as part of his job, no family history of heart disease, and has reported no distress of any sort. Three hours later he is dead at his desk.
A distressingly high number of heart disease patients have death as the first symptom.
Tris
So true. I haven’t seen many men scolding their women for being highly-dismissive of their symptoms in comparison to the inverse. So many calls to Doc Offices/ER’s start off with “My husband has been having these pains for x-number of days, and I can’t get him (blah, blah)…” then eventually he’s down hard and paying the price. (You listening out there, my male brethren???) 
The *Washington Post *runs a medical mystery column weekly in which they detail unusually difficult diagnoses. I remember one in which a young man had been fainting when he stood up. The concern was for a condition (alas, I forget the details) in which there is a surge of blood pressure and heart rate upon standing. The kid was sent to a lab and tested – there was indeed a surge of only one of the two (was it heart rate?), apparently ruling our the suspect condition, and he was treated accordingly. Things did not improve, and months later a doctor reviewing the tests noticed that there had indeed been surges of both heart rate AND blood pressure, but for reasons unclear, the medical staff involved had somehow locked onto the first item and been completely blind to the second. It was the suspected condition after all, of course.
I imagine this kind of tunnel vision happens from time to time in medicine; I know it happens in the safety field.
Edit: couldn’t find the story I was describing above, but here’s a link to several of these “Medical Mysteries” in case anyone is interested. Wash post links usually require registering an e-mail address but are free.
I had a sister-in-law die about two years ago when she had stomach cramps/pain, sort of like bad indigestion/constipation. She was triaged and was pretty much sent to the bottom of the order, and she died on the floor of the ER waiting room. Her innocuous or ‘benign’ symptom wound up bursting her bowel and she died.
I had a deep vein thrombosis after leg surgery. The only symptom was that I was a bit sore behind my knee (nowehere near either the surgical site OR the clot). The physical therapist who had come to evaluate me, on a hunch, had my surgeon send me back to the hospital for doppeerizing, which revealed a huge clot near my hip joint. May well have saved my life.
Here’s a shout-out to all the intermediate medical professionals! You rock!
THANK YOU THANK YOU THANK YOU.
I had a medical condition about 15 years ago (cancer). Last week, my doctor wanted to do a CT scan for routine monitoring. “Whatever”, I said.
Then I saw this post, looked up the NEJM article, pissed my pants, then spent the rest of the day going through the literature (I love being a scientist, since I have access to the journals and the knowledge to interpret the data and stats).
Based on these data, I can’t believe that ANY CT scan is approved for routine screening use - in an emergency, sure, but for routine diagnostics? I am already nervous about the CT scans I had as a teenager, plus the radiotherapy, but I can’t do anything about that. But I can control what happens now.
Called my doctor, told her my concerns and she scheduled an ultrasonogram instead.
Why not use sonography or MRI for screening? Much safer.
KarlGauss, sorry to call you out like this, but you’ve completely misrepresented what was in that NEJM article and the AIM article it was based on. “A single unnecessary CT scan is estimated to lead to a one in eighty chance of cancer,” is more accurately stated by that article as, “the risk of cancer from a single CT scan could be as high as 1 in 80 .”
The risk played for headlines in the particular article linked to by KarlGauss, IMHO, is at the extreme, extreme, upper estimate for risks related to CT scans, and that is only for a particular situation, not for all CT scans. For example, that same set of authors estimates the risk of a fatal malignancy of a head CT in a 50 year old woman at 1 in 10,000. I think the methodology of that article, and the Annals of Internal Medicine article parrots sucks, but I don’t have time to address it in depth right now. I’m happy to go more in depth later if someone asks. In reality, we just don’t know if the ionizing radiation from CT scans poses an increased risk of death from malignancy or not. All of our estimates are based upon data from survivors of the Japanese atomic bomb blasts, and the assumption that there’s a linear dose response without a, “maximum safe dose,” threshold. It’s not a bad assumption to make in the face of a lack of real evidence, but don’t confuse it with solid science. Also, the starving, war-stressed population of Hiroshima and Nagasaki in 1945 and their successive medical treatment for malignancy probably isn’t a totally appropriate comparison for the patients getting stuck into CT scanners today.
Here’s another article from NEJM, that in my view, is much more balanced in looking at typical CT protocols. And the results here are that the absolute worst case scenario, an abdominal CT of a nearly newborn baby girl, might result in a risk of fatal malignancy of 1 in 714. You’ll also notice that those risks drop off exponentially with age, and once you’ve reached the fourth decade of life, I think its fair to call them negligible.
http://www.nejm.org/doi/full/10.1056/NEJMra072149
Here’s some more food for thought:
A balanced set of “point/counterpoint,” reviews in the journal Radiology:
http://radiology.rsna.org/content/251/1/13.full.pdf
http://radiology.rsna.org/content/251/1/6.full.pdf
And this: