Today’s winners of the Veneficus award for failing miserably at physical exam and history taking are:
In third place: was a PCP who dx a pt with rheumatoid arthritis (without a positive rheumatoid factor test) and treated it for 10 years not noticing it was acromegaly which was causing the increase in the size of the hands, feet, and head, not joint inflammation, secondary to a pituitary tumor.
In second place: the gynecologist who dx a patient with early menopause who also had acromegaly and a pituitary tumor from her chief complaint of amenorrhea in her late 2nd decade of life, which is probably a 1 in a million if it was actually the case. If not a first in history. Fortunately her optometrist noticed the gross acromegaly when she made an appointment for blurring vision and “glasses not fitting right.” (which was actually compression of her optic chiasm by the tumor mass and her elongating nose extending the anterior/posterior distance of her head)
But the undisputed physical exam failure of the world for 2010:
And today's winner of the Veneficus award for failing miserably at physical exam and history taking.
Wait for it…
The PCP who for 5 years treated a patient for lower lumbar pain (which was really a spinal fracture caused by breast cancer metastases) who had an auto amputated breast that she didn’t tell him about because the pt found it embarrassing and didn’t want to be dx with breast ca.
So why is he the winner? Because he dx and treated only off of chief complaint and history, without ever performing a physical exam, noticing that one breast was considerably larger than the other, or the smell of rotting flesh from her decaying torso. (These guys wonder why they are paid so poorly.)
At the ripe old age of 40, she is bed confined on palliative chemo with multiple vertebral fractures,other axial skeletal fractures, with multiple bone and CNS metastases.
Today’s honorable mention was none other than one of my classmates, who when asked by the head of the department to percuss the borders of a pts heart replied: “I wasn’t prepared to do that in oncology sir, and we could just refer him to cardio for an ultrasound because we don’t actually percuss now- a-days.” ( I forsee him spending another week in the decelerated oncology rotation program)
But if I may, since I was asked to share my thoughts here instead of on a blog, turn this into a learning experience for EMS.
In case anyone didn’t hear, EMS providers are supposed to be the experts of out of hospital care. It also probably didn’t escape notice that every EMS vehicle doesn’t have a lab or various radiology devices on them.
For years, physicians (prior to EMS providers)actually went to peoples’ homes, which strangely enough had less diagnostic equipment in them than on an ambulance. But there were still Dx and treatments. (not all and not highly accurate always, but some)
I have heard that many EMS providers would like to help out in various calamities and disasters around the world. But I am not interested on a referendum on what they need for that.
I would like to point out that those environments often lack all the fancy diagnostics and things like running water.
Now practice makes perfect, and EMS providers are best positioned to practice the more “technology independent” assessments on every patient they see, every day of their career. In mastering these techniques, they provide valuable knowledge and skill that soon may not be replicated anywhere else in healthcare without great insight, effort, or old age.
That sounds vaguely like a "professional” quality.
So I would like to encourage all the EMS providers to learn all there is about physical exam and history. To take every opportunity to practice those skills beyond: “air goes in and out, blood round and round.” To take pride in your ability and expertise that one day may be found nowhere else in medicine. So when the power goes out, or society relies on you to be the best and only austere environment providers, EMS professionals are no longer a want. They are a need.
(sorry there is not possibly enough characters or time for me to type out how to perform these skills.)
But I would like to point out that you need education and patient contact to master these abilities, it cannot be done on Youtube or by following the cookbook protocols. EMS will never outpace medicine for treatment, but it is becoming apparent that EMS, being where the people are and not isolated from them by walls, glass, and technology like other healthcare providers, could finally be recognized for the value it has always been and not just a glorified taxi.
Become the EMS provider of tomorrow, we already have enough of them for today.
Lastly,
Don’t seek to win the Veneficus award for failing miserably at physical exam and history taking. It is less prestigious than a Darwin award because the winners apparently kill other people instead of themselves.
In third place: was a PCP who dx a pt with rheumatoid arthritis (without a positive rheumatoid factor test) and treated it for 10 years not noticing it was acromegaly which was causing the increase in the size of the hands, feet, and head, not joint inflammation, secondary to a pituitary tumor.
In second place: the gynecologist who dx a patient with early menopause who also had acromegaly and a pituitary tumor from her chief complaint of amenorrhea in her late 2nd decade of life, which is probably a 1 in a million if it was actually the case. If not a first in history. Fortunately her optometrist noticed the gross acromegaly when she made an appointment for blurring vision and “glasses not fitting right.” (which was actually compression of her optic chiasm by the tumor mass and her elongating nose extending the anterior/posterior distance of her head)
But the undisputed physical exam failure of the world for 2010:
And today's winner of the Veneficus award for failing miserably at physical exam and history taking.
Wait for it…
The PCP who for 5 years treated a patient for lower lumbar pain (which was really a spinal fracture caused by breast cancer metastases) who had an auto amputated breast that she didn’t tell him about because the pt found it embarrassing and didn’t want to be dx with breast ca.
So why is he the winner? Because he dx and treated only off of chief complaint and history, without ever performing a physical exam, noticing that one breast was considerably larger than the other, or the smell of rotting flesh from her decaying torso. (These guys wonder why they are paid so poorly.)
At the ripe old age of 40, she is bed confined on palliative chemo with multiple vertebral fractures,other axial skeletal fractures, with multiple bone and CNS metastases.
Today’s honorable mention was none other than one of my classmates, who when asked by the head of the department to percuss the borders of a pts heart replied: “I wasn’t prepared to do that in oncology sir, and we could just refer him to cardio for an ultrasound because we don’t actually percuss now- a-days.” ( I forsee him spending another week in the decelerated oncology rotation program)
But if I may, since I was asked to share my thoughts here instead of on a blog, turn this into a learning experience for EMS.
In case anyone didn’t hear, EMS providers are supposed to be the experts of out of hospital care. It also probably didn’t escape notice that every EMS vehicle doesn’t have a lab or various radiology devices on them.
For years, physicians (prior to EMS providers)actually went to peoples’ homes, which strangely enough had less diagnostic equipment in them than on an ambulance. But there were still Dx and treatments. (not all and not highly accurate always, but some)
I have heard that many EMS providers would like to help out in various calamities and disasters around the world. But I am not interested on a referendum on what they need for that.
I would like to point out that those environments often lack all the fancy diagnostics and things like running water.
Now practice makes perfect, and EMS providers are best positioned to practice the more “technology independent” assessments on every patient they see, every day of their career. In mastering these techniques, they provide valuable knowledge and skill that soon may not be replicated anywhere else in healthcare without great insight, effort, or old age.
That sounds vaguely like a "professional” quality.
So I would like to encourage all the EMS providers to learn all there is about physical exam and history. To take every opportunity to practice those skills beyond: “air goes in and out, blood round and round.” To take pride in your ability and expertise that one day may be found nowhere else in medicine. So when the power goes out, or society relies on you to be the best and only austere environment providers, EMS professionals are no longer a want. They are a need.
(sorry there is not possibly enough characters or time for me to type out how to perform these skills.)
But I would like to point out that you need education and patient contact to master these abilities, it cannot be done on Youtube or by following the cookbook protocols. EMS will never outpace medicine for treatment, but it is becoming apparent that EMS, being where the people are and not isolated from them by walls, glass, and technology like other healthcare providers, could finally be recognized for the value it has always been and not just a glorified taxi.
Become the EMS provider of tomorrow, we already have enough of them for today.
Lastly,
Don’t seek to win the Veneficus award for failing miserably at physical exam and history taking. It is less prestigious than a Darwin award because the winners apparently kill other people instead of themselves.
