 We all have those times when a patient says something to you and you go, what the f***? Welcome everybody back to the channel. For those of you who are new around here, my name is Michael, aka Dr. Chalini and I am a board certified diagnostic and interventional radiologist. On today's video, we are going to be talking about yet another BuzzFeed article. Yes, that's two incredible BuzzFeed articles in the past, like two weeks now. They keep cranking out some good articles that pertain to what we talked about on my channel. So might as well go over this one because it's just as fun. So basically this article talks about when a doctor is interviewing a patient and the patient says, Oh, I forgot to mention something. And that something completely changes the management of that patient. And I know it's a little confusing to you, but hopefully after I read a few of these, you'll get what I'm talking about. And let's go ahead and get into it. Let's go. So just briefly hear the article talks about how one of the things that doctor or dentist or medical professional is supposed to do while meeting a patient is discuss symptoms and the medical history. That's the first thing we do when we talk to a patient. Now, I obviously don't do this as much anymore because I feel that we don't really interview patients like someone in primary care would. But nonetheless, I can relate to a lot of these and you'll see why. But the main part of this article is that sometimes you interview a patient and they tell you certain things and then they leave out certain specific things that they don't feel matter at all. But those little things that they feel that don't matter at all oftentimes completely change management entirely. But it may just be common to them and they overlook these things but they are really important to us. Here are some examples of just that. Number one actually pertains to me. A lady presented for acute abdominal pain and the MRI indicated that she was pregnant. She knew she was pregnant but she didn't tell the physician. Now, this actually happens quite a bit. I don't know. Sometimes people either don't know they're pregnant or just forget to mention or feel like you should just know these things. I can't tell you how many CTs I've read in my time say a patient who is a trauma comes in and they are pregnant. We had no idea beforehand. And of course, a lot of times we do take beta-HCG levels before we do a CT to ensure that the patient is not pregnant but sometimes if they were doing an MRI it also should be taken note that the patient is pregnant because many different reasons but there have been some times where it slips through the cracks and there you go. Now, this obviously doesn't happen that much in the US but it could happen somewhere else. I don't know where these doctors are from. Our number two, this also pertains to my field. See, I told you these just happen in my field too even though I'm not a primary care doctor this stuff happens to me too. So number two, my dad had a patient who forgot to mention that they had cytosine versus meaning that the arrangement of the organs were a mirror image of normal anatomy. Now I see this not too uncommon but it always kind of trips me out a little bit when I see it on an X-ray or a CT scan because my first thought is someone put the image in backwards and then I started looking at things and I'm like, oh, everything's completely mirror image of what it should be in normal anatomy. And like this patient, they only mentioned it after a few minutes of my dad having a hard time hearing the heartbeat. So for that instance, you'd be hearing the heartbeat in the left side of the chest or left of central but in this patient maybe you hear it right of central so it's a little off. Mainly when we're doing like a CT scan, the liver which is usually in the right upper quadrant will be in the left upper quadrant and the spleen will be in the right upper quadrant when it's supposed to be in the left upper quadrant. So it kind of like throws us off a little bit. All right, number three here working as a dental hygienist I always review and update medical history and ask if there are any changes. Many patients will say, well, nothing related to my teeth. Like what, your teeth aren't part of your body? While I was cleaning someone's teeth we were chatting and the patient mentioned how he had a heart attack in a bypass a couple of weeks ago. And then the dental hygienist said, sir, I don't think it's the best time for your dental cleaning, go home and recover. So now I always asked, are there any changes in your health, recent surgeries or hospitalizations? And this is pretty big because if you have like to say a mechanical valve or whatnot, you shouldn't be getting your teeth cleaned without either being on antibiotics or off your blood thinners, et cetera, et cetera. So for this particular patient, it may have just been like routine. Well, I didn't have any surgery to my mouth so I should be fine, right? But everything matters and that's why we asked these questions. So yeah, number four here, doctor here, I had a baby come in for surgery. The parents reported no prior history. I asked why the baby has a gastrosomy tube and the parents were like, oh, he has laryngeal Malaysia, AKA floppy airway. And for some reason, they thought that wasn't important during surgery that they mentioned that the baby who would be intubated for anesthesia has laryngeal Malaysia or laryngeal Malaysia. I don't know how you say it correctly, but nonetheless, probably important to mention that when your baby has surgery. Some of these are really long so I'm going to go to some of the shorter ones maybe. We had a patient who came into our OBGYN department with complaints of vaginal bleeding, they invade abdominal pain for the second time in a month. She assumed his irregular menses probably due to some hormonal imbalance or stress and wanted some medication for it. While she was talking to us, she suddenly felt weak and fainted. Once she gained consciousness, she assured us that she was fine and probably because she skipped breakfast that morning or maybe because she is anemic. We asked her to get a pregnancy test done just in case along with a routine ultrasound, but she insisted that she was actually fine and just needed some medication. At our insistence, we got the pregnancy test done and it was positive, of course. Turns out the patient had a ruptured ectopic and she was going into hemorrhagic shock because of the bleeding, hence the fainting. That's what I thought of anemia, especially in these 10 patients. So thankfully they were able to manage her immediately, but upon further probing, we realized that she had a previous history of ectopic pregnancy, but she didn't think it was significant to mention. This is why it's so important to mention all things, especially serious cases like this. The problem is a lot of patients don't know if it's important or what's important or what's not important. So they just kind of pick and choose what they think pertains to what they're doing on that specific visit. But we need to know everything because medicine isn't black or white. It's very much a gray area and we have to kind of deduce things based on all the history and all that kind of stuff. So every bit of history is important. There's one thing we realized by this video. Tell your physician everything, because everything is important. Okay, moving on. I went to see someone who had been shot in the arm. He was in complete pain, swearing at us, uncooperative, and wouldn't let us ask questions. We got him to the hospital ASAP and the police met us and asked us if this guy was the one who had been run over. We said no, but then the guy piped up that it was. He had actually been run over by a car wheel and we had no idea. So the patient was shot and they were focusing on that, but I guess the patient failed to mention that he was also run over by a car and they should probably attend to other things as well. All right, number nine here. I was a student when this happened. A man in his 20s or 30s came to the ER with a headache. He said it was terrible and it seemed so. Everybody thought it was a bad migraine because he started vomiting. After that, I started asking him if this had ever happened to him and he told him that he was seeing a neurologist for a year, but lost the appointment and never came back. This is very common, by the way. I saw the guys from neurology and told them about the guy even when my superior had told me to send him home. Something in my gut was telling me to make sure there was not something more. When they examined him, they ended up doing a CT on his head and he had a tumor covering almost half of his brain and this happens, I'm not gonna scare people. I feel like this happens a lot, maybe because I'm a radiologist and I see the worst. So I just have a high likelihood of seeing this kind of stuff. I've had a lot of folks come into the ER throughout my time as a physician, just with a headache that is intractable. They've had this headache for years, six months, et cetera, et cetera. And we end up finding a brain tumor, which is why the ER will scan patients' heads quite a bit because you never know what's causing that headache. This one, number 11, is actually very common. I wasn't a medical practitioner, but a case worker. One dude had a noticeable drinking problem like physically damaging. I don't know if that is the medical term for that, but I asked him if he had been drinking recently, and he said, no, not really, just a case last night. So a lot of these patients, especially the after-hologians who end up in the ER with cirrhosis and liver failure, they drink a lot, but to them, a case of beer may not be that much. Sometimes people drink a case of beer in the morning and a case of beer at night, or one bottle of vodka in the morning, one bottle of vodka at night. So to them, it'd be like me saying, oh, I had a glass of wine last night, because to them, that's not really that much. A friend of mine mentioned in passing to her doctor that she had some pain in her right eye when she looked to the side. Her doctor immediately made an appointment with an ophthalmologist and she was diagnosed with multiple sclerosis. Because they caught it early, very little damage had been done and she's doing really well. Again, hear this quite a bit. And even recently, one of my friends who is an optometrist was telling me how she sees a lot of papillodema in the eye and has diagnosed many brain tumors just by a routine eye exam. So you can see a lot through the eyes. What is this saying? Like the gateway to the soul is through the eyes or something? Or the eyes tell all? Or something like that? What's that saying? I can't remember. Next, number 16, we had a kid who came into the ER who was bouncing on the trampoline the day before and hurt himself. The following day, it hurt too much, so his parents took him to the ER. He wasn't crying, it could move fine. He had a helical fracture up his entire leg. How in the hell was he walking on that for a day? Yeah, you'd be surprised, especially in young kids. Their bones and their cartilage, they're like rubber. They can bend and break and sometimes they'll have extreme pain and sometimes they'll just be able to walk normally like this particular kid. Pediatric population is very weird when it comes to injuries. They're either really injured and you can tell or it's very subtle and you have no idea they're injured and then you get an x-ray and they have a huge spiral fracture in their fremer. Really random. All right, last one here. We'll just end on number 18 since that's the last one. And yes, there are 18. I will leave a link to this article below so you can go look at it and read them all at your leisure. Number 18 here, we're working as a hygienist. There have been so many times when I go over a patient's medical history and the list of medications, they say no changes. And then the doctor comes in and they go, oh, I had a heart attack last month or oh, I just had my hip replaced and the doctor looked at me like I did something wrong. So this, I think probably every med student or anybody who presents to a higher up person like an attending physician to a resident she can't tell you how many times in med school and residency I went in to talk to a patient. They gave me a whole story and then you bring the attending physician in and then the patient just decides to open up and tell them everything that they didn't tell you and it makes you look so dumb, but this happens so often. I have no idea why. Maybe they just think med students are like, whatever, I'll tell the real doctor everything. This always happens and it makes you feel like you're like this big. Anyways, hope you all enjoyed these. That pretty much sums it up. Again, I'll leave this link in the description below to this article. You can go check it out. And as always, make sure you smash like, subscribe button, follow me on Instagram and TikTok if you don't already. Follow me on Chalini Rounds podcast. New podcast every Sunday on Apple iTunes and Spotify and wherever you listen to podcasts. So check us out there. And as always, I'll see you in the next one. Bye.