Went in to see a patient who'd been wheezing and congested. He was a 25-week preemie, now two years old, and had a history of asthma. I didn't hear any asthma. I saw a small, skinny boy with a cold, and I went back and told my Dr. H so. She went in and saw him and got into a long conversation with his parents about his asthma regimen and how she was going to put him on 5 days of corticosteroids. I was, to say the least, nonplussed.
Back in the staffing room, she turns to me, and says:
You're going to be frustrated with this one. Your exam was perfect, I want you to take that away with you. You described to me exactly what I saw. Your presentation was also very good - to the point, without leaving any thing out. What I'm acting on here is my experience. So I'm sorry, because this is not a good teaching case. You did everything right.
Thank you, Dr. H. Thank you for taking the time to apologise and thank you for letting me know that I'm presenting the cases in an acceptable manner. I've been so worried. And thank you for reaffirming that in your criticism of my write-up. It was far more helpful to hear "You had such a good case history in the oral, I would have liked to see more of it written down." than to be criticised.
Heard the story of the 14-year-old who was just sitting around doing nothing when some persons unknown came after him. So he went inside and locked the door. And they kicked it in, and they beat the crap out of him. Oh, and took his money. And now he's here in the ER. Apparently persons unknown beat the crap out of him a couple of months ago, while he was just sitting around doing nothing too. As the resident is telling Dr. B the case presentation, he comes to his plan, and says: "And my plan tonight for the human piñata is..." We all fell over laughing. One of the other residents says I can tell you what you'll never find me doing: walking down the street, by myself, minding my own business. That's when everything happens.
The police came and everything. And shortly after that, in the silence of an empty Urgent Care Clinic, Dr. B turns to me and says "Do you want to go home early?" Hell, yes. "Sure," I say, like a Good Medical Student who remembers that when they say "Go home early," you're supposed to go. So I was home by nine, and had delicious enchiladas, and it was a Good Day.
Have been beseiged with comments and questions about amoxicillin and mono. I'll begin by reminding you, O Best Beloved, that infectious mononucleosis - mono for short - is a viral infection that causes some interesting abnormalities in the cells in one's blood. Its most serious complications include viral meningitis and a ruptured spleen. There is no treatment, but when the tonsils are enlarged to the point of being disruptive to the patient's health, corticosteroids can be used. Giving antibiotics is pointless.
Giving antibiotics is done sometimes, often when mono is mistaken for strep throat - as they have similar presentations - or when there is a concurrent bacterial illness. This is often seen in children who have mono (anyone down to the age of 2 and up to about 40 can commonly get it, and the youngest case my staffing docs have seen is 4 months).
The deal is that 3-15% of patients with mono get a most disturbing allergic-type rash. It's relatively benign, but frightening. If you treat a patient who has active mono (Epstein-Barr Virus infection, most of the time, although there's a cytomegalovirus variant) with either amoxicillin or ampicillin (amoxicillin with clavulinic acid), the chance of that rash occurring goes up to 80%.
It is far better for the patient's psychological health, and from a treatment standpoint, to use a different antibiotic. There are lots that one can use, as strep throat is exquisitely sensitive to antibiotics. And that's the mono story. You can get a longer version here.
Am now going to go play Scrabble with LC.