Doctors indeed make the worst patients

I know general practice MDs don't spend a lot of time reviewing 12 lead ECG presentations.  I know this because I interact with general practice MDs who, in some cases, are not aware that the technology has made its way out of the cath lab.

No, really.

68 years old, obese, stressed, diaphoretic, pale, clearly in distress.

Stop me if you've heard this one.

History of MI with cath a few years ago, running to catch a flight when anything above the speed of a slow shuffle has not happened for years.

4 Lead shows PVCs, profusing, and the 12 lead dongle is already being assembled when the patient chimes up, "Listen guys, I'm a family Doctor and I can tell you don't do many of these EKGs, I don't need one."
I didn't laugh out loud, I'm very proud of myself.

"Let's have a quick look then and talk about what we find.  After all, as an MD you'll be able to interpret the findings alongside us and we can discuss options."

He's refusing an NC, ASA and nitro, as they often do, and is not improving.  Big surprise.  As V6 is attached and the machine is switched into 12 lead acquisition, my cellphone rings.  I don't often answer during a call, but it was an astronaut on board the international space station calling to tell me he can see a massive STEMI Anteriolateral over my shoulder.

I see it too.  So does the Rescue medic, the ambulance medic, the pilot walking by, even the tourist sitting nearby who asks if that is recording an earthquake.

"You can't tell from a field EKG if I'm having an MI, I'll get one at home."

The mental gymnastics he attempted was commendable but he finally gave up, mainly because he was exhausted.  With embarrassment he accepted the NC and a nitro spray, which almost immediately calmed him, and we began the transport.

"I'm still not convinced," he mumbled as the ambulance medic handed me an IV bag to spike.

"Oh, no. No, no, no, I want an RN to perform that skill please."

Eyes rolled as he mentions "My veins roll," and I was excused.  I smiled at the medic and she smiled back awkwardly, not looking forward to the next 15 minutes.

Doctors do indeed make the worst patients.


Anonymous said…
Glad he refused nitroglycerin, since giving it before a 12-lead may violate your local protocol.
The Happy Medic said…
With no elevation or abnormality in II or III, hypertensive, diaphoretic, history as I mentioned are you really going to withhold nitro? While the research indicates that IF the right inferior artery is involved and IF nitro is given it MAY "precipitate a drop in systolic blood pressure."
In most systems a lack of evidence of changes in II, III or AVF does not eliminate the indication of nitroglycerin. Had I seen changes in II and III before running the 12 I would not have indicated nitro until I looked at V4R.

Withholding possibly therapeutic medications is never the right answer. Local protocols that still say so need a new Medical Director.