Wednesday, October 21, 2009

Consults I Dread Seeing

I'll be honest. I think I had pretty good medical training, and I consider myself to be pretty damn good treating certain conditions like thyroid nodules/cancer and pituitary problems. Having said that, there are some consults I really dislike seeing, often because of misinformation to the patient from the referring physician, or misguided expectations. In random order:
  1. Weight gain- "It must be the thyroid because you can't lose weight. Never mind that your TSH/fT4 were normal"
  2. Fatigue
  3. Night sweats- I saw one of these patients yesterday- she was a nurse and was befuddled when her referring MD punted her to me. She actually asked him, "My thyroid labs are normal- why are you sending me to an endo?"
  4. Hair loss- unless this was thyroid or hyperandrogenism in nature, please do not promise the patient I can help them grow their hair back. A dermatologist would be smarter then I am in that regard. Believe me if I could treat this I wouldn't be putting up with thinning hair myself
  5. Adrenal fatigue- despite a robust AM cortisol, and/or a normal ACTH stimulation test. I don't want to start a debate since I know what the believers say, but the science says otherwise. And I consider myself a scientist.
  6. Low libido
  7. Mood swings- (are you kidding me? My WIFE gets these. Heck, I get these myself)
  8. Decreased muscle strength- I see a few of these regularly, usually bodybuilder types who are already benchpressing >150 lbs and have biceps the size of sequioa tree, but still aren't happy they aren't getting stronger. Some of these eventually make it known that they are hoping for anabolic streroids
  9. Wanting a bigger penis- no, I kid you not. Seen a couple. Nothing I could do, unfortunately
  10. Syncope- this one probably wins the prize, and I've gotten a handful of these from, of all people, a cardiologist!
Not that I'm downplaying any symptoms, just that there are some things the science and medicine and research has shown to be hormonal in nature. Many others, however, are not, and when the GP promises a cure from me (I suspect it's usually a case of them not having the foggiest idea and so making a blanket statement of "it MUST be your hormones" without actually having found any abnormality), is often counter-productive to the patient and a waste of their time. I can't say it's a waste of my time because the patient ends up paying to see me, but I do wish I saw fewer of these, and more of the stuff I can actually help people with.


Blogger dHarjma said...

hey dude i just got a 45 yo lady on armour thyroid 240mg (60 x q6h)/ day, diarrhea for 8 yrs, PV bleeding q2weeks on OCPs, a fib, HTN on THREE antihypertensives, complaining she thinks her armour dose is too low because she's gained a few pounds?!

apparently some complimentary medicine doctor prescribed it saying the only way tx hashimotos effectively is to have TSH levels undetectable..

3:31 PM  
Blogger vagus said...

yea i can totally relate to that.
these people should be sued.

8:25 AM  

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