Case #2: 31 year old female with history of surgically operated prolactinoma presents with recurrence of headaches, galactorrhea, possible bitemporal hemianopia, and dysmenorrhea (remember prolactinoma should cause amennorhea). A prolactin level is 3,900, MRI shows a 3 cm tumor pressing on the optic chiasm, and transvaginal ultrasound revealed endometrial polyps. The patient asks the student how soon before she moves to a room upstairs.
Tapa: Creating patient expectations for disposition before a definitive plan has been finalized can give patients false hope. In the aforementioned scenarios, the patient in the first case was kept overnight for observation with a stress echo in the morning, and the patient in the second case was discharged home with follow-up to Neuroendocrinology clinic and her gynecologist.
It is important to have an open relationship with your patients, and be honest about their disposition status. If you are unsure of a patient's disposition, do not offer them a definitive plan until you have discussed it with the primary (admitting/consulting) team.
Another important take home message can be gained from these examples. Mistakes will happen. They are inevitable in the learning curve of medicine. As doctors/students we must recognize these humbling moments and be honest and open with our patients. Numerous studies have shown that patient's value honesty in their physicians, and that patient care is not just about doing what's right for the patient, but also admitting when we are wrong.
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