Tuesday 12 April 2011

Diagnostic Formulation

The acute medical ward referred a patient to me, for urgent assessment.

The patient had been perfectly well until 2 weeks ago when she experienced left sided weakness and slurred speech that she and her husband have been very worried about. She'd become confused. The medical team referred her to me "with dementia" to sort it all out.

She's had a stroke.

The history, clinical course, clinical examination and structural brain imaging yield a diagnosis of a stroke.

She was perfectly well a fortnight ago. She does not have dementia.

The medical team (well to be fair, a junior doctor on the medical team) assert otherwise. She thinks I'm being unhelpful, not curing this woman or taking over her care "to manage her dementia." I explain she's not got dementia. The junior doctor continues to assert that she does.

I'd love to do this :


pj said...

I deeply hope it was a little more complicated than you're telling it!

To be fair to the junior, they may well not believe it either but they've been tasked with getting you to take over the oatient by their seniors (who are naturally nowhere to be seen).

I well remember forcing three different psychiatrists (plus a neurologist) to see a patient of mine with blatant Wernicke's because my seniors thought he was 'psychotic'.

medstudentitis said...

so... she has vascular dementia? Lol, just kidding.

Jobbing Doctor said...


Doctor Zorro said...

You could always try the old fashioned approach.
"Me Consultant, you junior. I'm big, you're small, I'm right you're wrong, I talk, you shut up & listen.

Or is that a little too orthopaedic?

Little Miss Sunshine said...

Ooh, jeez. I hope I'm not that pig-headed as a junior doctor.

Milk and Two Sugars said...

Perhaps the junior doc could do with your professional assessment?

The Shrink said...

PJ, tragically it really was that simple.

Dr Zorro, being mindful that as PJ's said the medic was no doubt just doing what they were told to do, I didn't get all Consultoid on her. Although just following orders hasn't been seen to be a decenent defense in the past :P

LMS, M&2S, I'm oft times accused of too positive in my disposition, since I can imagine the junior doctor having just been on call, or being harrassed by discharge facilitators to get the patient out, or being told to get Psych to take the referral, or being insecure and asserting confidence as a veneer of competence as very junior newly qualified medics are wont to do, and presumably I was just as irksome until the years have kindly robbed me of such recollections :)