Sometimes you need a nugget of medical information – pronto. If your patient has been in a hospital, you likely have access to reams of data. Finding your nugget may take seconds, minutes, or hours. You may never find it.
A number of years ago, Dr. Kamal Thapar, a Wisconsin neurosurgeon, gave a talk on how Facebook provided the nugget he needed to save his patient’s life.
He saw a 56 year old unresponsive patient in the emergency department. CT of the brain showed a large hemispheric ischemic stroke with mass effect. In fact, there were multiple strokes.
The comatose patient provided no history.
She had been seen in 2 ERs over a couple of weeks. One system sent over health records, by fax. It was difficult to tell what was going on.
The patient’s son explained she had a Facebook account. She had been a meticulous documenter of her medical history. The son helped gain access. The woman had posted medications, symptoms, hospitalizations, and treatment going back months. Only the relevant stuff.
Putting the pieces together, the medical team diagnosed an atrial septal defect and cardiac aneurysm which caused and propelled emboli going to the brain. The patient was timely treated and made a good recovery.
This brings me to two other patients.
Each had surgery by a plastic surgeon. Each seemed to have a good result. Inexplicably, both lashed out at their surgeons on online review sites.
In the first case, the patient was ultimately diagnosed with bipolar syndrome. Once treated, she regained control of her life. And she was embarrassed by how she reacted online.
The second patient had a history of breast cancer. She was post-mastectomy and her surgeon performed a breast reconstruction. This patient attacked the surgeon online and suggested she would destroy his career.
This made no sense.
At the time I wrote this post, I don’t have a full explanation as to what fueled this rage. But, before attributing this behavior to an unhappy patient with access to the Internet, it makes sense to see if there is a medical reason for this activity. She had breast cancer which was treated by mastectomy. It’s possible she had metastatic disease to her brain. A large frontal lobe lesion might cause disinhibition. Such a mass could cause a patient to lose her veto control over all thoughts that would otherwise be kept in check.
The facile conclusion to being on the receiving end of such online rants might be: “The patient is angry. I never saw it coming. I wish I had never touched this patient.”
In the medical world, sometimes the words posted online are a clue to an underlying diagnosis.
Make the diagnosis and you can help the patient.
Once the patient has been helped, then ask them to tell the full story.
Of course, it’s also possible the patient is unhappy and just wants to vent and perhaps you never should have touched the patient.
What do you think?
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