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OK, Sports fans...it's Saturday night, 3 am and time for inter-service hospital ping pong. Staff Internal Medicine has won the tossup and has elected to receive. The other services are in position and here comes the first patient!!
Chief Complaint: "feel bad"
History: Mr. Amos Leeks, 59 Y/0, 385 pound alcoholic, diabetic, hypertensive male with history of three old myocardial infarcts, angina, congestive heart failure, COPD, chronic renal insufficiency, gout, hypothyroidism and "nerves."
The Medicine service jumps into position. Dr. Shafer Goodloe, medical raconteur, man-about-town and big time babe magnet gets the nod from the referee. Shafer enters the room with a spotless white coat, stiff bow tie and gleaming implements of destruction hanging from every pocket.
The clock starts....Dr. Goodloe jauntily saunters into the room and sidles up to the patient with a big cheesy smile....
"Hi there Mr. Leeks...ever been in the Army?"
"Yeah, but they threw me out for flat feet."
"Well....in the interest of continuity of care, we feel that you should return to a Veterans Administration Hospital. The doctors there are familiar with these problems and they can follow you in perpetuity"
PINGGGG!
"Naaaa...I don't like that place. The nurses are ugly and they let a bunch of smart ass kids in white coats practice on me when they thought I wasn't looking....I want to stay right here and have you take care of me."
FOUL! Serve again....
Shafer assumes his most intense young doctor countenance.....
"Hi there Mr. Leeks....... got any pain right here (does hand stand on Amos's right upper quadrant).
"Arrrggghhh!"
PINGGGG....Surgery consult.
"Hello, Surgery...we got a guy down here with excruciating right upper quadrant pain, mild jaundice and a history of fatty food intolerance." He needs to be on the surgery service.
"What else is wrong with him"
"Oh, just a few minor medical ailments"
"How much does he weigh?"
Oh, maybe three hundred and.." (click)
PONGGGG!
Shafer's face darkens..........
"Say...Mr. Leeks....ever taken any Valium?"
"Yeah....someone gave me some once."
PINGGGG! Psychiatry consult...
"Hello, psychiatry...we got a guy down here who looks pretty depressed. May be suicidal. Has a history of Valium abuse. He needs to be on the Psych service."
OK, just have him sign a consent for electro-convulsive therapy and send him around in the morning. We'll buzz him till he sees God."
"What about his work up?"
"What about it?" (click)
PONGGGG!
Shafer begins to sweat and his bow tie droops....the other services nervously shift from foot to foot....
"Say...Mr. Leeks.....got any pain here? (pops Lumbar 5 with ball peen hammer).
"Yeeeooouuch!"
PINGGGG! Orthopedics consult.
"Hello, Orthopods...we got a guy down here with exquisite low back pain radiating to both legs, he needs to be admitted to Ortho."
"What day is today?"
"Saturday"
"Sorry, back pain only on Tuesdays and alternate Thursdays. Make him a clinic appointment for three weeks." (click)
PONGGGG!
Metaphorically speaking, Shafer takes the gloves off...No more Mr. nice-guy....
"Hi there Mr. Leeks.......have any pain in your head? (Shines quartz-halogen light in left pupil dilated with homatropine)"
"Hoooooaaaaaaaaarrrrrgggggghhhhh!"
PINGGGG! Neurosurgery consult.
"Hello, Neurosurg....got a guy down here with an exquisite headache accompanied by flashing lights and not relieved by anything. He needs to be admitted to you."
"Hey....no problem...get him a CAT scan with and without contrast, lumbar puncture, angiogram, EEG, put him on your service and we'll consult on him in the morning" (click).
PONGGGG!
Medical team calls time out, stops the clock and pulls into a huddle. As they whisper and murmur..a Senior Medical Student pops up to see if the patient is still there...he is. After a moment they break and return to the game with broad grins.
"Hello...OB-GYN....we got a woman down here with an imperforate hymen, adreno-genital syndrome and bilateral femoro-labial hernias...."
Whoosh.......Crash...
Point..Set..Game!
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