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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)

- This guy told me he had pink eye.

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B1 中級 美國腔

"Reddit醫生"#第3條:第二意見 ("Doctors of Reddit" #3: Second Opinions)

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    鄭伃庭 發佈於 2021 年 01 月 14 日
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