Wednesday, July 26, 2006


Today the doctor I usually follow was on vacation so I followed one of his partners. He only had one patient scheduled in the morning at clinic, so I went with him to the (small community) hospital afterwards to round on his patients. Two were newborns who both seemed to be doing well, the only concern was that the parents of one of them had Hepatitis C, so it will be important to watch the infant's liver function. The family of the other infant only spoke Spanish, so we had to have an interpreter (who asked the nurse after we left the room if the doctor was married [yes with several children]. Yesterday one of the female medical students who is engaged was proposed to by an AIDS patient, leading to the question, does anyone bother to look at people's left hands anymore?).

There were three adult patients. One had heart failure, but is not improving as expected, the doctor thinks there is something else going on, so he brought in a cardiologist for a consult. Another patient had an exacerbation of emphysema, but is doing well and should be able to go home tomorrow. The last patient was admitted for a urinary tract infection that was thought to have moved up into the kidneys to cause pyelonephritis. However, she has been on antibiotics for several days, and still complains of pain. The doctor and all the nurses are 99% sure that she is faking, hopefully some tests that were ordered today will clear that up. After the doctor visited her and told her she might be able to be discharged today, she asked the nurses to get another doctor for her because she didn't think this doctor was "caring and compassionate" enough (rubbish), thereby convincing everyone that she is faking. This obviously is a complicated situation, because one doesn't like being taken advantage of by a patient, or knowing that thousands of dollars are being spent on her for nothing, but at the same time, there is a small possibility she might really be sick, in which case discharging her would not be good.


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