Dr. Google and Mindless Optimism

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One night on call, I heard this overhead page: "Code Blue - In front of Cheryl's Cookies."  Typically the [seemingly] 1000 calorie cookies just aid in killing you slowly, but I guess they worked more swiftly that time.

[The patient was fine for those of you insulted by my dark humor.]

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A term we use often in medicine is "functional" to describe something that we can't explain and by process of elimination assume that it is rooted in psychological distress. If a surgeon diagnoses a patient with "functional abdominal pain" the underlying message is often - "it's all in her head" because there is no pathology we can find associated with the symptom.

A patient with psychogenic non-epileptic seizures (aka "pseudoseizures") was being interviewed about how her life has been affected by these seizures.  PNES are thought to be psychological in origin and have no biological basis.  In an attempt to explain that she wanted to get back to her normal activities, the patient exasperatedly stated, "I just want to be FUNCTIONAL!"  If she had only known that she had just made her own diagnosis.

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A patient who had been consulting Dr. Google came in stating, "I think I have Bell's Palsy.  I don't have the facial droop, but I have everything else!"  Apparently Dr. Google didn't tell her that the ONLY diagnostic criteria for Bell's Palsy is facial droop (unilateral facial paralysis).

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One patient suffering through a terrible case of paralysis as a result of Guillain-Barre syndrome had a poster on his wall that said "PMA" which he explained to us stands for "Positive Mental Attitude".  As he was explaining his mantra, my German attending interrupted him saying, "It's so American - this mindless optimism.  You have a right to be grumpy if you want to be!"

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Pt: "Hey Doc, can I get some Viagra?"
Dr: "Tell me more about what's going on."
Pt: "I don't know, but my wife really needs it!"
Dr: "Wait, so you want a prescription for your wife to take it?"
Pt: "Yes!  It works that way too, doesn't it?"

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One attending I was working with described a patient as having "nascar-opathy".  I later found out that this was his way of describing patients with fever than 4 teeth.

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