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- This guy told me he had pink eye.
He had metal shards in his eye from welding.
Oh my god.
Can that happen?
Hey, guys.
Doctor Mike here.
Welcome to the third episode
of responding to Reddit threads.
This week's response video is gonna be to the thread titled
"Doctors of Reddit, what's your thank god they came in
"for a second opinion moment?"
I know mine.
Are you ready for me to tell you?
Bee-whoop.
I'm working in an urgent care,
and the last patients on my schedule
happen to be part of a family.
And when I walk into the room, they're covered in bruises.
They looked horrible, like in horrible condition.
It almost looked like they belonged
in a level one trauma center.
I asked what happened.
They told me they were coming back from a road trip.
Unfortunately, they got into a car accident
driving, like, 70 miles an hour.
They were treated, let go,
but they were still having so many symptoms
that they wanted to come see me.
My first question was, "Give me your records."
Show me what tests were done
in this place where you were treated.
They give them to me.
I look and it's like, okay,
scan one, scan two, scan three, labs, this, that.
Everything looks decent.
Where is the scan of the head
to make sure you're not bleeding inside your brain?
And they're like, "Oh, they told us we shouldn't do it.
"We didn't need it."
And I'm thinking to myself, "That's crazy."
Not only is one of the family members
on blood thinning medication,
but they were involved in a 70 mile an hour car accident.
So despite the fact that it was very difficult
to get them to the ER for the second time that day,
I made it happen.
We got them there.
And what do you know?
They were scanned.
One of the family members, bleeding into the brain,
ended up staying in the neural ICU,
and is effected to this day.
Had they gone home, not seen me, went to sleep,
the outcomes would've been much worse.
So that's my thank god for a second opinion moment.
Now it's time for me to read and react to yours.
Well, not yours, but Redditors.
Are people on Reddit called, ah, sorry.
My dad went to the same ear doctor for around nine years
due to poor hearing and was told there was nothing wrong.
When he finally went to a second doctor,
they referred him to the hospital
and found tumors in his ears that had eaten entirely
through his inner ear bones and ear drums.
He needed four operations to remove them,
one every six months.
If the second doctor hadn't offered their opinion,
he probably would've had tumors
eating through the back of his skull into his brain.
Well, I don't know if that's true,
but the fact that you're going
to see a doctor for nine years,
and you have a loss of hearing,
and they're telling you everything's fine, that's wrong.
You have a symptom.
If they're not curing the symptom
or addressing the symptom
or explaining why the symptom is there,
they're not doing their job.
Are you yawning during my Reddit thread?
That's so rude.
(Bear licks)
ER nurse here.
Had a lady in for simple pneumonia.
Her 13-year-old son was getting bored,
so I showed him some equipment.
I connected a simple heart monitor to him
and discovered he was in complete heart block.
I printed a strip and showed it to the doc.
We suddenly and unexpectedly got a cardiac patient.
Yo, that's crazy.
That's like in medical school
when we're all listening to each other's hearts,
practicing, and then we find out someone has,
like, a serious heart condition.
That's crazy.
I had a doctor in high school who was unconcerned
when I suddenly developed vertical double vision,
which was freaking out everyone in the emergency room
where I had gone initially,
and I had lost 60 pounds for no reason.
That's an insane amount of weight loss.
It was only a year or two later when I told him
that my arm would fall asleep much faster than normal
when I raise to ask it a question in class
that he thought there might be something wrong with me.
MRI ordered.
Brain tumor found.
Bear, isn't that crazy.
(Bear licks)
Bear doesn't sound concerned.
That's a crazy story to me,
because the first question you ask,
even if you're remotely concerned about a cancer history is,
"Do you have any weight loss."
Unintended weight loss, specifically.
And when they say, "Yes," that encourages me
to start scanning and looking
for things that I normally don't check for.
Having a 60 pound weight loss
should automatically be a red flag.
Raising your hand and having it fall asleep on you?
Not a huge red flag.
That could be simply an issue with cervical radiculopathy
which means that your vertebrae,
where the nerves come out between your vertebrae,
can get impinged and cause symptoms
that shoot down the nerve or cause it to get,
for you to develop some numbness or tingling.
60 pound weight loss?
(sharply exhales)
That's major disease unless proven otherwise,
and I think Bear agrees.
(kiss)
Dermatologist here.
I have seen probably five instances
of my other doctor told me it was fine that were melanomas.
A lot of times people don't want full skin exams.
There are lots of perfectly sane reasons for this,
time, perceived cost, history of personal trauma.
However, I routinely find cancers
people don't know they have.
Keep this in mind if you see a dermatologist for acne
and they recommend you get in a gown.
Yes, there's so many patients of mine
that I recommend that we do full skin exam
or maybe even offer them a referral to the dermatologist
and they pass up on it.
Melanoma's one of those cancers
that's growing in diagnoses,
and it's one that can be incredibly dangerous
because it spreads when it metastasizes
to really weird areas of the body like the eye, bone.
Like, these are problems
that you just want to avoid with careful screening.
Psychiatrist here.
A 30-year-old man with mild depressive symptoms
was in and out of the hospital fairly quickly.
He as under pressure from his home life,
living with four roommates
who were making life a bit difficult for him.
No suicidal thoughts.
He was cleared of all psychopathologies
by me and two other doctors.
A few months later he came back.
Same symptoms,
however this time he talked about five roommates.
It felt wrong, and I digged into his story,
tried to contact his roommates.
He lived alone and was severely psychotic.
I have no idea to this day
how he hid it so well from everyone.
When we scan for psychosis, we look for inconsistencies
between the patient's subjective experience of thinking,
being, and acting, and the objective reality
accepted by the general cultural norm.
This patient managed to live in a subjective psychotic world
that just fit so well with the objective reality
that tricked several psychiatrists, including myself.
In this day and age, it's very easy for that to happen.
We want to be as understanding and open
and non-judgemental as possible.
However, if you're trying to establish
whether a patient is basing their current situation
in reality, sometimes you have to ask probing questions.
But now, there's an art to this.
You can ask questions by making yourself seem very curious
as opposed to inquisitive as if, like, you're a detective.
That little change in tone can go a long way,
especially with a patient
who may be psychotic or psychologically ill.
(stammers)
(ululates)
(Annoying Orange ululates)
An elderly gentleman was brought in
by his concerned adult children for chest pain.
He wanted to believe his primary doctor
that it was some gas or heartburn,
but his son just had a gut feeling and made him go to the ER
with everyone so he could get checked out.
Heart attack was imminent.
Like, we weren't sure if treatment would take effect
in time to prevent it.
Declared code blue, means heart stop, all hands on deck.
Place went from very quiet,
empty ER to sheer chaos in minutes.
There is no doubt in my mind
that this gut feeling saved his life.
Wow.
Knowing your own body
and being a good advocate for yourself,
or having a family member that knows you well
and is a good advocate for you is crucial
in getting better health outcomes.
That's why those who don't have an extended family
or are not married generally have worse health outcomes
because they don't have someone to advocate on their behalf.
I got a moderate traumatic brain injury in October,
and the week after I got home from the hospital
I wasn't' acting like myself,
was refusing to eat, and just didn't make much sense.
My mom called the doctor a few times.
They said it was normal,
but to take me in if anything changed.
She took me in on Saturday, a week later,
because I started slurring my speech
and was unsteady on my feet.
The injury caused my sodium levels to drop from 140 to 119.
That's quite dangerous.
This in turn caused stroke-like symptoms which were,
in reality, a small series of seizures.
Yeah, electrolyte imbalances are no joke,
and sodium levels, potassium levels,
calcium levels all need to be kept in homeostasis
by your body's organs in order for you to stay alive.
Any disorder that,
whether it makes those levels go up or down,
can have life or death consequences.
Can you imagine?
Potassium can kill.
Makes you think about eating bananas.
Just kidding.
You can eat bananas and nothing bad will happen
because your own body's organs will decide
how much potassium to take in,
how much to let out, so on, so forth.
Went to my family doc
with the worst headache of my entire life.
She dismissed it, telling me it was a tension headache
and I should take a Tylenol and lay in a dark room.
First of all, when a patient says,
"I have the worst headache of my life,"
you don't even think as a family medicine doctor.
You say, "Are you certain of this?"
You clarify, quantify, ask some questions.
You send them to the ER
because the worst headache of my life,
that specific explanation,
what is also know as a thunderclap headache,
it's something that needs to be checked
with a CAT scan right now
because we're looking for bleeding.
Over the course of the next month,
I saw her a total of 13 times,
each time with worsening symptoms.
First it was dizziness, then vomiting,
then eventually I could no longer see out of my right eye.
Every time she told me it was a tension headache
or a weird migraine, gave me a prescription
for pain killers, and sent me on my way.
The final straw was when I could no longer walk properly.
I would try and take a step,
but all I could manage was this weird shuffle.
She reluctantly agreed to send me to a neurologist.
The next day I showed up at his office
and was there for less than a minute.
He took one look in my eyes
and immediately called an ambulance.
Turns out I had hydrocephalus.
My ventricles were five times the size
they were supposed to be
and my brain was literally being squeezed out of my head.
Go figure.
Hydrocephalus is a really scary condition
because that increases pressure and the ventricles,
which are the spaces within your brain,
actually start swelling from increased fluid
and actually start pushing the brain
and increasing pressure on it which can cause your brain
to herniate out of the brain stem.
Oh my god.
That's just an awful condition.
Can result in death.
I'm an emergency medicine doc in the Midwest USA.
The patient was transferred from rural nowhere
to our tertiary care facility,
big hospital with every specialist.
Call was of really bad quality,
but the transferring physician described
a 21-year-old male that had rapid heart rate
and breathing rate, low blood pressure, low oxygen,
confusion, and a severe opacification on his chest x-ray
on the right side, diagnosed pneumonia.
He gave him a ton fluids, started antibiotics,
put him on a ventilator,
but he wasn't getting better and wanted to send him to us.
Sure, send away.
An hour later, the gentleman arrives, looks young,
fit, and not the type to just drop dead from pneumonia.
We roll him onto our stretcher and find
a huge stab wound in his back.
The x-ray finding was his entire right chest
was full of blood.
We put a tube in it, gave him some blood,
and he had to go for surgery to fix the bleeding.
Lesson, look at your patient.
This is why one of the biggest lessons
that I learned working at a level one trauma center
as a medical student is the first thing you do
in an emergency, in a trauma situation,
inspect the entirety of the patient,
especially when a patient is unconscious
because, when they're unconscious, they can't tell you
that they have a stab wound in their back.
But unless you check that,
you won't know why a patient is in shock.
Experience while doing residency in China.
Kid came in via reference from his village doctor.
He had a few random episodes of seizures.
Well guess what.
Imaging at our hospital showed
that there were a few multiple larva cysts in his head.
Yep, kid loved to go to the rivers
and put frogs in his mouth.
He wouldn't eat them, but he would just lick them.
Don't ask me why.
Not gonna lie, I probably would not think
about larva and frog licking
as part of my history taking here in New York City.
Maybe there's more that I need to learn.
You gotta check out my other two Reddit episodes right here,
or if you want me to compare what it's like
to be a real doctor versus TV doctor, click here.
And I'll see you in one of these videos.
Which one's it gonna be?
(hums)
(hip hop music)
コツ：単語をクリックしてすぐ意味を調べられます！

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上級 米

"Doctors of Reddit" #3: Second Opinions

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鄭伃庭 2019 年 11 月 19 日 に公開

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