* * Anonymous Doc

Wednesday, October 13, 2010

My two-week vacation starts Friday.

Not a day too soon. Clinic patient today. Came in last month for a checkup. He has hypothroidism, and his lab results were too high. I took a quick look at his chart, saw that he takes 100mcg of his medication, so I upped it to 125 and told him he really needs to take it.

He comes in today, lab results are even higher. "Why aren't you taking your medication?" "Oh, I am, I try, almost every day. I am taking it." "It doesn't seem like you are." "Oh, I will be better, I will, I am trying." Okay, whatever, everyone says they take their medication even when they don't.

I take another look at the chart.

And I notice that I didn't read quite so carefully last month. Because he'd actually been prescribed 2 of the 100mcg pills daily. 200 mcg. And I'd dropped it to 125mcg instead of bumping it up.

And so he'd probably been taking the medicine. He just wasn't getting enough of it. Because I am a terrible doctor.

Or at least a slightly careless doctor. Sometimes.

No long term issue, he's on the right dose now and he'll be fine. But, uh... oops?


  1. Terrible? No. Slightly careless? Perhaps. So learn from it and move on. Take that extra second to read the chart.

  2. Sounds like they should reformat the chart to say 200 mcg (two 100 mcg pills). Then no one would need to be careful.

    AnonDoc, can I ask you an off topic question that you probably don't have time to answer? What if you can't figure out someone's problem in fifteen-minute appointments, even after diagnostic tests? How can they get a more in-depth look at their condition?

    It seems like there ought to be another step up in problem solving from the basic doctor visit. "I'll think about your problem for fifteen minutes while I look at your test results" sure wouldn't get many results in the plastics factory. You need multiple tests, discussions with coworkers, and reference materials just to fix a rough surface on a piece of plastic. So my question is, is repeated doctor visits the way to go, or should is there a way to find someone who can do some in-depth research on me personally?

  3. Oh no, not terrible. That's nothing. I had a two year resident puncture my lung while I had Guillian-Barre Syndrome (port for the plasma pharesis) and blame it on me, because the continuous jabbing caused me to puke on him.

    I had a neurologist of 20+ years misdiagnosis me with MS for three years based on completely negative testing again and again. He didn't think my chronic B12 deficiency might be causing any of my problems, and the malabsorption problems I have with iron and Vitamin K and Calcium was of no consequence either.

    I have been sent home by a two year resident with kidney stones and a kidney infection, because she confused me with the drug addict next to my little sheeted room in the ER.

    There's more, and they all make your very minor mistake look so much smaller. Finally though, a two year resident caught my last kidney infection (10 in two year's time) and discovered my Crohns Disease - the reason for my stones, my infections, my malabsorption, anemia, peripheral nerve problems (that untreated B12 problem). Sometimes doctors aren't just eager to get your complaining out of their office. Sometimes they are even smart and helpful.

    The best of luck to you, two year resident. Don't EVER send a woman with multiple large kidney stones, that are trying to pass, home with Tylenol. NEVER.