Sometimes in this job you just get lucky. You have an elusive and/or dangerous diagnosis just dropped in your lap. Something devastating that you would never have been able to tease out otherwise just gets handed to you by the patient. There’s a catch, though: you have to be smart enough to know when to listen to the patient, when not to blow off their crazy talk as just crazy.
So it was recently when I saw a guy with back pain. From the chart, it didn’t sound like anything complex: a middle-aged to older guy, maybe 60 or so, with a history of chronic back pain and multiple surgeries for the same. He was on Oxycontin 80 mg three times daily (a very high dose, and a red flag for an ER doc naturally suspicious of drug-seeking behavior). I went to see him, and it was clear in seconds that this dude was JPN: Just Plain Nuts. Read more »
*This blog post was originally published at Movin' Meat*