I spent a month on the trauma surgery service. There is clinic every Friday, in which we see patients who have been discharged from the trauma surgery service to remove sutures/staples, ensure their pain is properly managed, and make sure they don't have any signs of post-operative complications (infections, etc). On my first day, I went in by myself to see a patient. He was a middle-aged guy who had gotten beaten up by "a gang of dudes" one night while "minding his own business." (NB: every trauma victim is minding their own business when tragedy befalls them. I have made it a personal goal to never be minding my own business. It seems quite dangerous in this city). His incisions were well healed and he only needed staples and sutures removed from several sites on his back. After checking in with my attending, I set about removing them, cleaned the sites, and told him he was free to go, but to be sure to call us if he had any problems.
"Doc, what about my blood tests I got when I was here?" Despite my normal announcement that I'm a medical student working with the team upon entering the room, many patients still refer to me as their doctor. It's uncomfortable (because it's inaccurate, because it sets an expectation I'm not ready for, and because people -- attendings, residents, other students -- would make fun of me if they ever found out). Not sure to what he was referring, I pulled up his record on the computer and realized that, while in the emergency room, he'd gotten some routine blood tests that basically said...nothing. I explained what the tests were and that they indicated normal blood counts and electrolyte levels in his blood at the time he was seen in the ER.
"So you're saying I don't have syphilis?"
.....what?
"I just got out of lock-up and the state keeps calling me and telling me I have syphilis."
.......ummmmmmmmmmmm
"Well we didn't test for syphilis, so I really can't say one way or another. If they tested you for syphilis in prison and the results came back positive, I think you should follow up with them and get treatment. It's a very simple antibiotic that you would have to take."
"So you're saying I don't have syphilis?"
"No, that's not what I'm saying. I'm saying I don't know based on what we did here. We did not test for syphilis."
"But you said my blood tests are normal."
"Yes, the blood tests we ran are normal. But there is a special test for syphilis that a doctor can run. It also uses your blood, but it is a completely different test from the one we ran. We did not test for syphilis."
"Well I don't think I have it. I had a test with my doctor once and she said I didn't have it."
"That's definitely possible. If it's a recent test, I think it is probably correct. However, if this was in the past and you've have any additional sexual partners since your negative test, you could have gotten syphilis between the test and now. Perhaps that is why your test from prison is positive."
"Doc, I'm a one woman man!"
"I don't doubt it. But syphilis can be a very serious disease if left untreated, even if you currently feel well now. I really think it's very important for you to follow-up with these tests. If you have a recent negative test from your primary care doctor, I'm sure she'd be happy, with your permission, to send it to the state so that they stop calling you. But I really do think you should follow up with here. It's important for your health and that of your sexual partner."
"So you're saying I don't have syphilis?"
This conversation probably went on for about 20 minutes. I finally got to a point where I thought I had somewhat conveyed the pertinent information and stood up to leave.
"Doc, what about these staples in my head? You gonna take them out?"
The previous note from the ED hadn't said anything about scalp lacerations or the placement of staples in this man's head. Nor had he said anything when I asked if the locations on the back were the only ones. But sure enough, beneath his tangled head of hair, he had two well healed lacerations on his scalp with lines of 20-30 staples in each. Since he had delayed his follow-up much past the recommended two weeks, his hair had grown in and around the staples, intermixed with scabs, and made a hot hot mess.
Having never taken staples out of the scalp before (and the scalp can bleed...A LOT), I went out to the physician work room to see if there was anything special I needed to do. Also to make sure someone else was there in case I ran into trouble with unexpected bleeding. No one. Everyone was gone. Clinic ended at noon and my patient's 20 minute confusion about syphilis had pushed the appointment way past clinic quitting time.
"Guess I'm winging this one alone," I thought to myself. And proceeded to remove 40 staples from the head of a recently released prisoner with questionable syphilis status.
"Doc, what about my blood tests I got when I was here?" Despite my normal announcement that I'm a medical student working with the team upon entering the room, many patients still refer to me as their doctor. It's uncomfortable (because it's inaccurate, because it sets an expectation I'm not ready for, and because people -- attendings, residents, other students -- would make fun of me if they ever found out). Not sure to what he was referring, I pulled up his record on the computer and realized that, while in the emergency room, he'd gotten some routine blood tests that basically said...nothing. I explained what the tests were and that they indicated normal blood counts and electrolyte levels in his blood at the time he was seen in the ER.
"So you're saying I don't have syphilis?"
.....what?
"I just got out of lock-up and the state keeps calling me and telling me I have syphilis."
.......ummmmmmmmmmmm
"Well we didn't test for syphilis, so I really can't say one way or another. If they tested you for syphilis in prison and the results came back positive, I think you should follow up with them and get treatment. It's a very simple antibiotic that you would have to take."
"So you're saying I don't have syphilis?"
"No, that's not what I'm saying. I'm saying I don't know based on what we did here. We did not test for syphilis."
"But you said my blood tests are normal."
"Yes, the blood tests we ran are normal. But there is a special test for syphilis that a doctor can run. It also uses your blood, but it is a completely different test from the one we ran. We did not test for syphilis."
"Well I don't think I have it. I had a test with my doctor once and she said I didn't have it."
"That's definitely possible. If it's a recent test, I think it is probably correct. However, if this was in the past and you've have any additional sexual partners since your negative test, you could have gotten syphilis between the test and now. Perhaps that is why your test from prison is positive."
"Doc, I'm a one woman man!"
"I don't doubt it. But syphilis can be a very serious disease if left untreated, even if you currently feel well now. I really think it's very important for you to follow-up with these tests. If you have a recent negative test from your primary care doctor, I'm sure she'd be happy, with your permission, to send it to the state so that they stop calling you. But I really do think you should follow up with here. It's important for your health and that of your sexual partner."
"So you're saying I don't have syphilis?"
This conversation probably went on for about 20 minutes. I finally got to a point where I thought I had somewhat conveyed the pertinent information and stood up to leave.
"Doc, what about these staples in my head? You gonna take them out?"
The previous note from the ED hadn't said anything about scalp lacerations or the placement of staples in this man's head. Nor had he said anything when I asked if the locations on the back were the only ones. But sure enough, beneath his tangled head of hair, he had two well healed lacerations on his scalp with lines of 20-30 staples in each. Since he had delayed his follow-up much past the recommended two weeks, his hair had grown in and around the staples, intermixed with scabs, and made a hot hot mess.
Having never taken staples out of the scalp before (and the scalp can bleed...A LOT), I went out to the physician work room to see if there was anything special I needed to do. Also to make sure someone else was there in case I ran into trouble with unexpected bleeding. No one. Everyone was gone. Clinic ended at noon and my patient's 20 minute confusion about syphilis had pushed the appointment way past clinic quitting time.
"Guess I'm winging this one alone," I thought to myself. And proceeded to remove 40 staples from the head of a recently released prisoner with questionable syphilis status.
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