I sent a teenager to the hospital recently. He is an intense athlete – a long and medium distance runner – and had come to me with the acute onset of severe bilateral back pain that radiated around both flanks into his groin. Long-story-short – CT did not show kidney stones, etc., some muscle enzyme tests were mildly elevated (not in rhabdomyolysis range), but his creatinine was over two-and-a-half times normal, meaning a serious and sudden hit to his kidneys – so I called him and sent him to the hospital that night.
Turns out he’d been taking ibuprofen (not outlandish doses) before each run, and the nearest a peds nephrology buddy of mine could fathom was that it was a perfect storm of ibuprofen, intense exercise and a little subclinical dehydration – enough to accomplish some acute tubular necrosis. The nephrologist and I have actually talked about that before – as recently as a week prior – especially in smaller kids with fever and gastroenteritis – a common telephone advice is to control the fever with ibuprofen – but in the setting of dehydration, this can be dangerous.
So, an interesting case – indeed! But to explain the title of this post? I made it up to the hospital to do social rounds on the morning after his admission. The whole peds nephrology team was there, so I thought I’d listen and contribute what I could.
Nephrologist [to the medical students]: So, one of you start the history.
[nervous twitters, then one of them speaks]
Med Student: So, what brings you to the hospital?
Adolescent Patient [mother sitting beside him]: Well, I had some back pain last night, so I came to the ER.
Med Student: [continues the history]
What???? No he didn’t!!!! He came to MY office! I saw him, took the history, did the physical, looked at the UA, ordered the appropriate testing, discovered the problem, and sent him to the hospital.
I’m standing in back of the medical student looking directly at the patient, who knew I was there (as did his mother), and nobody corrected this! Not wanting to seem desperate for attention, I didn’t say anything, but geez…
I’m used to the studies that show that physicians “remember” saying things to the patient that the patient doesn’t remember immediately upon leaving the office…but ENTIRE VISITS?