A quick look is worth more than words can ever say.

01/10/2010 at 5:50 AM Leave a comment

Patients do not appreciate how I do my job. I routinely get questioned about a symptom. “My throat is sore.” they want a diagnosis. Clearly if it was that easy they would have replaced my with a computer, or these days, an APP.

The ‘presenting symptom’ or ‘chief complaint’ as we call it is only the very beguinning of the visit. It cuts the universe of potential problems significantly but half of infinity is still infinity. It is even worse on the phone. “I have had this rash for a week” does not help very much.

What I realized the other day is that the amount of useful, vital information that I can glean form a glance is enormous.

Case number one: I am interrupted because there is a patient in triage that is Severely SOB (Short of Breath, he may also be an S– o- B—) but that is generaly not relevant. I go up front and look at the patient, perhaps even talk to them. Within a second or two I can evaluate how bad the SOB is and whether we need to do something that second or whether we can continue with the vital signs, paperwork and I will see him after I finish with the current patient.

I can get respiratory rate, and effort, color of lips and finger tips, fatigue, pursing of the lips, amount of distress in the patient.  I have seen patients at all stages of respiratory distress from trivial to mild, to serious (wether they are hidding it or maximizing it) to severe, to desperate , to needing intubation to terminal. It would be hard to describe where on that spectrum the patient is  with mere words.

Case number 2: in Pediatrics in the winter we get lots of kids with asthma attacks. Kids are amazing and they can be at the edge of respiratory failure and still be trying to act normally. Te time between the kid not acting normally and the danger zone is much narrower. But after seeing thousands of kids, it is easy to see someone as they come in and not only evaluate them but get them started on treatment. It helps that for the most part they dont come in with the problems older adults come in with.

Case number 3: Chest pain in a young person. It only takes a minute to decide that a young (20’s) person is not having an acute heart attack. It is very rare anyway, but within a minute I can decide how to sort it out and get the appropriate test started while I finish with my current patient.

That quick glance is vital to us. Some of that could be obtained in the so called virtual visit, other parts of it not so much. More on this in future posts.


Entry filed under: Doctor Musings, How things work, office workings. Tags: , , .

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