Had a 25 yr patient come in for her 6 mo diabetic retinal exam. Shes a AA who is overweight and several years past 75 but mentally sharp.

During exam she asked if i could give her something for headaches, right side, hurt to chew, temple to ear. I started questioning her about it and come to find out she had gone to the ER for the same kind of headache, but worse, about 10-11 days ago.

Well, what did they find. She couldnt remember but they gave her some pills and an injection and she got well, for several days but she said they made an appt for her with a neurologist. The ER doc said he would only give her enough pills in the rx for 1 week.

So, callec pharmacy. Sure enough, they were Prednisone. I asked her if the doc at the ER said anything about Temporal Arteritis. Bingo. She remembered that name. So, she had probably been given an injection of methylprednisolone.

Next question was when she ran out of the pills. Last week. When is the appt with the neurologist? 12 more days. Unreal.

How can they give meds for one week when the neuro check is 4 wks later. She would probably be dead or at least blind by then.

I called the neruos office and talked to his RN. Its 4:00 PM.

Good news. Send her to the ER and he will see her there in 2 hours.

PTL. Only by the grace of God was she scheduled for a diabetic exam today.

Temporal headaches in the elderly are often a semi-emergency. The vascular inflammation can back down to join other arteries and then progress up to the optic nerve or brain.

The doc @ ER needs to have his azz reamed by a pro! Thank God she was lucky enough to see some one who was alert, and cared! Hope she's OK.

Medical malfeasance!!

Kills more a year than firearms I believe.

Mike

Doc,

I may give you lots of guff on our favorite subject, but I have not doubt you are a fine Eye Doc.
Good Job helping this lady. You work a difficult location for a difficult demographic.

AS, i sincerely appreciate your kind words. Thanks and Happy Thanksgiving and may God bless you and yours.

It's not always that obvious in the ER for us. Although sometimes easier to get tests quickly, I have limited studies I can do at my disposal. I can't even order a MRI at all at one facility or obtain a ultrasound after 2:45. Been ER for 10 years now. FNP. Patients are mostly vague and cannot give reliable history it seems. I agree if that was the diagnosis they should have done a better job making sure she had higher dose prednisone for the time to get into her neuro or PCP. PCP do a terrible job getting patients in quickly and say just go to the ER rather than leave openings to see their own patients it seems. Not calling you out so don't take it that way. Seems you are a good provider who cares. Just in general.i appreciate you informing everyone to watch for this.

I see patients every day for things the PCP should have worked up or seen the patient for. The medical assistant tells patient we can't see you today go to ER. It's very taxing on us as ER is already overflowing. I personally saw 31 patients today with two strokes( transferred one to neuro interventionalist and gave TPA to the other), a respiratory failure I intubated, and a STEMI. Placed 104 sutures today on 5 patients. Busy doesn't even begin to explain it. Had two who said BP was still high after PCP changed meds and were told by nurse at PCP office to come to ER with a BP 160ish/100ish. Absolutely no reason to send to the ER for that.

My grandmother just got released Sunday from university of TN after seeing PCP twice in one week for blurred vision and headaches. New headaches at that. After finally calling me about her symptoms. Sent her straight to my buddy at UT ER. Giant cell areteritis(temporal arteritis)and although not blind she is now visually impaired. Guess I'm still a alittle hot that something obvious wasn't caught, just as you are it seems

Once again I'm not calling you out, just telling the non medical member the ER is very taxed and busy. We don't have the time to work every patient up with extensive work ups for non life threatening issues or people die in the lobby. Seen that before also. Most people should or could be seen by PCP versus the ER

Hell, our slit lamp is out of service and has been for 4 months. Didn't realize you were eye doc. Just venting about a lot of PCP. We are lucky we have a OPTHO group who takes call and are willing to see patients in ER for true eye emergencies, and works them in as needed. Now ENT, oralmaxilofacial, and neuro we have no access to. Catch lab is only available till 3 if no one on table. You could say limited resources at times

Thanks Doc!!
I appreciate your kind thoughts.
Have a great Thanksgiving. Hope you get to spend it with family.

Well done Jag 😎!

I don't recall ever getting crossways with you on here but even if I did, what a guy does trumps what him or a whole herd of natterers might say.

Ya did good by that Lady., congrats!

Kevin, i figure the ER doc had her scheduled with the neuro guy and was not informed of the timeline. I would have sent her to her PCP but she is retiring and only seeing patients 2 days a week. Sometimes things just fall through the cracks. I have never seen anyone be perfect all the time, including me.

No offense to those in the ER who have saved the bacon of me and mine a more than a few times, from asthma attacks as a kid to a car wreck as a passenger and a ruptured kidney cyst from an injury in high school and just last year on a weekend after problems developed from bowel surgery.

My wife and I were in a wreck just a little over a year ago. We hit a deer, and the collision totaled out our 2014 Explorer, as every air bag went off. When the air bag that was under the dash on her side deployed, the plastic that was holding it in place hit her lower leg, cutting it. It wasn't a deep cut, but the paramedic that responded to the accident thought she needed to go to the ER. She did, and the ER doctor never cleaned the wound, or really ever looked at it closely. He just smeared some ointment on it, and sent her home. About a week later, the leg was infected, and it took over 3 months to get it cleared up. That doctor failed to do his job, anyway you look at it. On the flip side, I've also had some positive experiences in the ER. It just depends on who is on duty.

Yea sorry for seeming heated a little. Just venting as I am going through this dilemma with my grandmother and it can be frustrating seeing people miss such serious but easily diagnosed illnesses. For those of us that take pride in what we do and truly are there to help people it makes our job much more stressful and difficult to care for the patient when someone drops the ball. Thanks for all you do for your patients

You sure caught a curve ball for that lady, Doc. Good on ya.

Good Job Doc!

Can’t imagine the responsibility that comes with being a doctor, it’s a knife that cuts deep both ways

Hard to imagine the good feeling jag must have about now helping that lady to dodge a serious bullet


Also hard to imagine what it’d be like to be the er Doc if jag hadn’t caught this.

Not for me, no thanks

. Grateful for all the great medical care available these days and the med professionals that put care at the forefront of their work

Far, far more.

Just remember...50% of the doctors out there graduated at the bottom of the class.

Gotta love the 50% rule. lol

Insurance companies and the gooberment has the medical field all bound up.
I think those two could use some help.

Lord help us all.

But not a single one of them came from the bottom 50% of their undergraduate class. Those who get in aren't dumb but a few sure have an attitude. Most are great people and very conscientious but there are those few...