- A patient with multiple broken ribs getting an unnecessary full cardiac workup "just in case" his chest pain is actually from a heart attack, not his multiple broken ribs
- A patient with a simple chest cold getting an unnecessary CT scan of the chest "just in case" it's actually a pulmonary embolus
- A child with a simple cold getting a prescription for antibiotics from the pediatrician "just in case" the parent complains about not getting antibiotics, even though antibiotics are worthless against the cold virus
- An ER doc calling for a ridiculous unnecessary surgical consultation for some bullshit reason just in case the doctor is brain dead and has no fucking clue how to actually work up a patient and make a diagnosis
Dr. Halfwit (not her real name) called me to let me know she was seeing a female patient who had pain in the right lower portion of her abdomen, and she was concerned about appendicitis. It sounded reasonable enough, so I told her to get a CT scan to rule out GPP - Girl Part Problems (that's the technical term), which can often masquerade as appendicitis - and call me with the results. A few hours later I just happened to be in the CT scanner room as her scan was being performed, and it took me all of 1.38 seconds to see her huge ovarian cyst on her right side - clearly the source of her pain - and her perfectly normal appendix. I told Dr. Halfwit what the CT showed and to call the gynaecologist for an evaluation, and I logically thought that would be the end.
HAHAHA, logic. Right. Emergency physicians seem to use logic like accountants use Erlenmeyer flasks or like lawyers use morals - not at all.
A few hours later (now around 2 AM), another ER doc (this one has perhaps 10% of a usable brain) who had taken over for Dr. Halfwit called me about the same patient whom she had not discharged and had now been in the department for over seven hours. The gynaecologist had seen the patient, correctly diagnosed her with a large ovarian cyst (hmm, where have we heard that before?), and had cleared her to be discharged home to follow up with her own gynaecologist as an outpatient. We have a diagnosis and a plan...so why the hell was Dr. Brainless (perhaps his real name) calling me? Just to verify the accuracy of his name? Maybe, though I'm not sure he even had the brain power to comprehend that he has no brain. Or something like that.
Anyway, Dr. Brainless explained to me that he wanted me to confirm that the gynaecologist's plan was ok. I paused as I waited for the punch line, because NOBODY can be that stupid. Right?
"Yes", he said, "I'm just covering my ass." He stared at me in anticipation, waiting for some sage wisdom. I stared back at him, dumbfounded, astonished, flabbergasted, and several other synonyms.
With a mighty effort, he mustered enough brain power to explain that he didn't feel that 1) an ultrasound showing an ovarian cyst, 2) a CT scan confirming an ovarian cyst and a normal appendix, 3) a physical examination entirely consistent with an ovarian cyst and entirely inconsistent with appendicitis, and 4) a gynaecologist confirming an ovarian cyst were enough to actually diagnose a simple ovarian cyst. No, Dr. Brainless needed a surgeon to help him with GPP. I told him to his face that he should be embarrassed that he can't rule out appendicitis and diagnose an ovarian cyst himself, let alone with multiple doctors and studies doing the work for him.
After I thoroughly lambasted him for his complete ineptitude, he made it very clear that he refused to discharge the patient until I examined her. I stared back at his dull, empty eyes, turned on my heel, marched into her room, performed my examination (which was shockingly consistent with an ovarian cyst), and reported back to Dr. Brainless that she did, in fact, have an ovarian cyst and that she could, in fact, go home. Then without another word I left, confident in my own diagnostic skills but entirely doubtful of Dr. Brainless'.