So below is a bizarre interaction I had with an anesthesiologist who is the daughter of a pt of mine.
So working a relatively normal shift, when I get word from my charge nurse that a doctor has parked in the ambulance bay reserved for priority 1 EMS and has wheeled in their father through this entrance demanding he be seen immediately by our “stroke team”. I ask the nurse if he has any deficits, which she replies “lol, no, the report she gave was that he was confused and now he is back to normal.”
They put him in one of our back rooms rather than putting him in one of our resus bays, which I am told infuriates her more.
So I purposely wait 20 minutes to see them because I want to establish that she will be seen on my time, not hers, also I had other pts to evaluate, as well.
I finally walk into the room to see this incredibly pleasant 80yo who is smiling at me as I walk in, and his 40 yo Karen of a daughter with her MD badge on that is pacing back and forth in the room.
I introduce myself to both of them and I quickly and thoroughly perform a full neuro exam that my med school neurologists would be proud of, sans tuning fork. Of course it is all normal.
The story is 40 minutes prior to arrival he began to have some word finding issues (while pt interjects “I was looking for my damn computer, but I briefly couldn’t remember what the name for computer was”.) He also apparently forgot the name of one of his grandsons (“I always forget his name” he interjects again). Because of this, his wife called their daughter who told them to rush him to the ER 30 minutes away from them (bypassing numerous ERs on the way), so that she has access to the hospital he goes to. This confusion episode lasts all of 10 minutes. He does have a hx CAD and HTN, so a CVA/TIA workup isn’t completely unreasonable, given I was not there when he was reportedly symptomatic.
I then state “I understand you are concerned for a CVA, you can rest assured that it is very unlikely he had a stroke based on the reported symptoms, the length of symptoms, and his current exam. Certainly TIA is possible, however, nothing that has been reported seems to be focal. I think it also could be delirium from something like medications or infectio…”
“ITS NOT DELIRIUM!!!”
“I’m not saying this is my definitive diagnosis, I’m just giving you my differential, and mild delirium can frequently presen…”
“I’M A DOCTOR, I KNOW WHAT DELIRIUM IS, THIS IS NOT DELIRIUM!! HE’S NOT SUNDOWNING, HE DOESNT HAVE DEMENTIA, HOW IS THIS CONSISTENT WITH DELIRIUM? His symptoms were ACUTE!”
“Ma’am, delirium typically presents acutely, I think you are confusing dementia with delirium.
“I ALREADY TOLD YOU IM A DOCTOR, I KNOW WHAT DELIRIUM IS! WHERE IS THE STROKE TEAM!?”
“You’re looking at it, and like I have already stated, he is not currently having a stroke. I think we are getting a bit ahead of ourselves, however, regarding diagnoses. I plan to get some cerebral imaging and some labs and we will reassess things in a bit. Now tell me, did he have any additional neuro findings at home like dysarthria, receptive aphasia, ataxia, facial droop, etc.?
“What’s aphasia and dysarthria? Like slurred speech?”
“Well dysarthria is slurred speech, yes. Aphasia is difficulty with communicating that comes in a receptive and expressive variety.”
“Well I wasn’t home with him, my mother was, she’s the one that drove him here, I just met them in the ambulance bay.”
“Okay, well how about we have you switch out with your mother, so I can get the story from her.”
“No, as a physician, I have more understanding of medicine and should be here with him instead of my mother. You can talk to her over the phone though.”
“What kind of doc are you again?”
“Anesthesiologist”
I proceed to give a not so subtle nod and a long and telling glance over to the pt’s nurse who knows me well and knows I am seconds away from breaking my currently civil demeanor.
I then speak with the pt’s wife (also very pleasant like the pt) over the phone who describes a very minimally concerning story, that doesn’t really sound anything like a TIA or CVA, but occasionally they present abnormally, so I’m not going to protest doing a TIA workup.
About 30 minutes later, a cardiac arrest comes in. The pt’s nurse finds me as I’m walking over to the cardiac arrest pt to tell me that the daughter is demanding to know what the pt’s ECG demonstrated (she says while rolling her eyes and says she’ll make sure the daughter knows I’m in a code).
I get ROSC back after about 15 minutes but still trying to get the pt stabilized. The nurse comes back to just give me a heads up that the daughter would like me to step out of the code to talk to her, which the nurse already informed the daughter I would not do (nurse mainly just telling me to vent).
Another 20 minutes go by as I’m placing lines. And getting the pt stable enough for scans, the pt’s nurse comes back to inform me the daughter is now demanding I step out to give her an update. The nurse then told the daughter that unless her dad is coding, he is not currently my first priority. I told the nurse that if she demands one more time for me to step out of a dying pt’s room, to have security escort her out of the ER.
I finally get this pt stable enough where I feel comfortable leaving his bedside. I decide rather than immediately going to see the daughter, I’m going to make her wait. So I make her wait another 30 minutes when all the work up is finally back, so I can go in there one more time and never step back in that room again.
I did not apologize for the delay. I let her know that he will be admitted to complete his TIA workup (mainly because I didn’t want to deal with the fight of discharging him) and that everything is normal so far. She asked that I make sure I get his MRI immediately which I told her would not happen. She then asked that a neurologist come and see him right now (at 11pm) which I told her also would not happen. She then left in a huff and switched out with her mother, who was an amazingly sweet lady. I don’t know how such wonderful people have such a “see you next Tuesday” of an offspring.
This is certainly not the first time I’ve dealt with ridiculous physician colleagues as a family member of a patient, but this was probably the most absurd. I never would have expected a ****ing doctor to be the one to demand I step out of a ****ing code to update them on their asymptomatic family member.
Sorry for the long post, I just needed an outlet to vent.
