As a medical specialist I like to stay in my lane. The patient may have heart disease, kidney failure, and emphysema but I try to only address the infection for which I am consulted. Well, I saw a patient for follow-up in the office the other day. He had multiple medical problems and had been hospitalized for a number of them. It was there that I was consulted for a bone infection. I placed him on a long course of intravenous antibiotics and now here he was in my office.
In terms of the infection, the patient was doing well. But he and his spouse spent the better half of the visit telling me about his fatigue, his recent creatinine (kidney test), and mostly his swollen arm. It was not the arm in which there had been a PICC. He had just seen his primary care physician two days earlier and stated he told him about the arm.
The arm was truly swollen and slightly red. I asked my nurse to help coordinate an ultrasound to evaluate for blood clots. That’s not an infection if you were wondering but I am indeed an internist. The ultrasound technician was quite accommodating so off the patient went and off I went to see about my other office patients. Thirty minutes later, the spouse now agitated calls stating that they were still waiting for the ultrasound and did it need to be done because she had somewhere else to be.
I was confused. If they had better things to do, why did they bring the swollen arm to my attention? Especially when it was supposedly already mentioned to their primary physician just the other day. I told them it was necessary. An hour later, the angry spouse marches back to the office stating that the ultrasound has been done and they’ve been told to contact the ordering physician (moi) for the results. Of course, the ultrasound had not yet been read so I did not have the results.
When we finally did get the results – a HUGE BLOOD CLOT – this did not temper the anger in the patient’s spouse. Now I was flustered because I had a blood clot on my hands, and I wasn’t sure what to do with it. Do I send the patient, this already angry family, to the hospital to start on blood thinners? Will they throw the vase at me for such a suggestion? Would they shoot me if I told them to go to the emergency room for further evaluation and treatment. What aggravation.
No good deed goes unpunished, I tell you.
Leave a Reply