Confidential

An emergency physician, by training (and, for me, by nature) wants things to be simple and straightforward. Often, patients show up with anything but simple and straightforward complaints. Sometimes they even come in with detailed notes laying out the course of their symptoms. I am sure they think that lots of details will help the doctor get to the bottom of whatever is making them ill. In reality, at least for me, the more complicated it is, the more I am sure I will NOT get to the bottom of it.

Here is a reproduction of a note I was given by a woman one night. My reading of this is not, “I need to pay attention to all of these details.” Rather, it is “This patient clearly has more problems to deal with than asthma.” Whether it is stress or some underlying personality or psychiatric problem, I see this note as evidence that I have no chance of fixing her problems in one visit to the emergency department.

Obviously, I have changed the names and details to protect the patient’s identity.

Sally A. Williams

CONFIDENTIAL

Asthma

• Current symptoms:
  • Chest feels warm
  • Some back pain while lying down (also pinched cervical nerve)
  • Still tired and hard to get out of bed
  • Terrible dreams where I am fighting to wake up
  • Hard to get to sleep
  • Hard to stay awake during the day even when using CPAP at night
  • Use rescue inhaler with limited success
  • Started Prednisone 25milligrams on 10/29 at 9:00, with slight improvement
  • Prednisone 10mg on 10/30 at 3:00 a.m. with slight improvement
  • Prednisone 15mg on 10/30 at 1:00 p.m. with limited improvement
  • Saturations run 92 to 99, with pulse high at 100-110 (Normal saturations 98-99)
  • Saturations worse the lower I lie in bed
  • Pulse rose to 126 beats approximately 7:00p.m. on 10/30/12
  • Flow Meter done on 10/29 and 10/30 measured 350-375
  • Feet swell if I am upright for even short time, very painful by night (taken off of Aldactone 25 mg by Dr. Jones in July 2012)

HISTORY

• Started Metoprolol 25 milligram ½ tab 2 times on 9/22/12
  • Became tired and started sleeping a lot
  • Sleep was disturbed
  • Advair 500/50 didn’t seem to completely work
    • Felt winded
    • Couldn’t seem to catch my breath
  • High humidity made it worse
  • Hoarseness usually became worse about 4:00 p.m. to 7:00 p.m.
  • Started to use rescue inhaler every few days
  • Last slight flu was August 2012
  • Saw Dr. Jones on 10/19 and she changed medicine to Diltiazem 110
  • Previous private patient of Dr. Smith – diagnosis was mild asthma but worsened greatly by colds and flu and general anesthesia
  • Previous private patient of Dr. Allen – diagnosis of unknown etiology for feet swelling

Zoloft for nighttime to help keep me calm due to stress of not being able to find a job?
Aldactone 25mg. 2x

10/30/12