Doctors: Uncertain Diagnoses, Patient Risk

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Same!

“I understand it happens to everyone at some point, but how do you handle it? For example, I think this patient has condition X and escalate level of care. Later I’m chart stalking and turns out they have nothing and I feel like an idiot. Also when you miss a bad diagnosis like brain cancer in someone with headaches... submitted by /u/No-Marzipan8555 [link] [comments]”

“If a patient does novolog 70/30 25 Units twice daily at home, how much long acting would you give while inpatient? Would 25-30 units long acting daily plus sliding scale be reasonable when you admit for first time? And then adjust later on? And when do long acting insulins usually show effect on glucose? Isn’t it around 3 hours or so? submitted by /u/Cookyjar [link] [comments]”

I know, my PICU brain is like…uh just put it on a pump people. Who knew?

“For real though. Edit: I am an elder millennial. Thank you fam for indulging me. Saw a patient this week for 2 wks breathlessness and chest pain after a URI. Vitals normal. EKG nonspecific. She looked like crap. I sent her to ER. I gave report to ER and basically said “vibes are off” but professionally. She was found to have pericardial and pleural effusions. TRUST YOUR SPIDEY SENSES FAM. Love y’all submitted by /u/thespurge [link] [comments]”

“I emailed my vet about this and not understand her response. My 12 year old cat (Fatty) went from stage 2 CKD (CRE of 173 umol/L) in May 2026 to sudden acute failure with a CRE of 1080 umol/L in July 2026. She was put on IV fluids right away but her CRE increased to 1200 umol/L and then 1333 umol/L. Additionally, her potassium started at a normal range but, about 24 hours into hospitalization, shot up to 7.8 mg. She was still producing urine. They called me after the potassium kept rising and sa”

“I guess I'm type B by this standard, but only because I'm not relying on someone's checkout alone for patient care. I'm gonna read the chart and see for myself.”

“Lol at that. I received a patient that both the notes and nurses say is AOx 5. Patient doesn't know where he is and others.....I was so, do I treat this as an emergent issue or ..... Sigh. Just take the shit. It's not their fault afterall, the system just there to fuck us over.”

“Hi! Family NP here. Have a patient who admitted to chronic ketamine use (multiple times per day) after we discussed some abnormal liver function and diffuse echogenicity on ultrasound. Does anyone have any good resources for helping people get off ketamine? He does admit it’s problematic and wants to cut down. We’re tackling the underlying anxiety but there isn’t really a lot of resources locally in terms of treatment programs. Thanks! submitted by /u/momma1RN [link] [comments]”

“I’m referring to the KDIGO rules, where in the absence of urine abnormalities. CKD starts when eGFR goes below 60 and stays there. I am notifying patients that they now have CKD 3a. I send them a non-alarmist patient portal message (no more NSAIDs, don’t get dehydrated, keep an eye on blood pressure and sugars). But because of KDIGO’s choice of words, they now have CKD 3a. “That’s half-way to dialysis! And you never told me about stage 2!” Or someone has a kidney removed, and predictably eGFR dr”

Legend. Thanks for the info!

“Today was one of those pharmacy days where you question everything. 😅 This morning, a 90-year-old patient came in with her daughter claiming that our pharmacy had given her nitroglycerin instead of her methotrexate. I looked at the bottle and noticed that the label on the nitroglycerin had the patient’s name on it, but it looked completely different from our pharmacy’s labels. I explained that the nitroglycerin bottle was not dispensed by our pharmacy and suggested that the medication may have”

Nope, all IV

“Once on a pulm elective, I met a woman who'd spent more than a month on ECMO (forget why) and was, like...essentially okay, just chilling there on the floors. She was neurologically intact and only on 2L of oxygen, walking around with PT. I previously had no idea you could survive that, let alone return to almost baseline.”

“I've seen a patient in legit 10/10 pain. It was harrowing and brutal. He begged for someone to kill him so he wouldn't be in pain anymore.”

“How does your hospital handle acute therapy orders and upgrades in care? We do not seem to have an exact policy in place at my location and I am curious on your thoughts. We are having some debates amongst the staff about putting something in-place. Some therapists at my location believe that an upgrade in care from Med-Tele to PCU warrant new acute therapy orders due to a straight up change in status (with the current orders placed under med-tele discharged), while others argue that the jump in”

“Exactly. I gave a dude 12, yes, 12mg of IV dilaudid at once while he was standing up and talking to me. If you would have walked by, he wouldn’t have looked in pain. But he was. He was in a sickle cell crisis. The dilaudid didn’t even touch him. Just kept right on talking to me through it.”

“Received a trauma transfer - a victim of DV w/a head injury, intubated, fully dressed , no foley. You’d think the first hospital might want to cut the clothes off for a quick head to toe, checking for other injuries like contusions, bruises, puncture wounds. But no.”

“How fast do you push cardizem for SVT patients? I work in the ED and saw someone push it fast and it almost had an adenosine response to the patient’s rhythm (minor/temporary flatline), but everyone seemed chill with that. submitted by /u/Winter_Reality_9652 [link] [comments]”

“Im a new grad on a Cardiac PCU floor about to get off orientation and I made an error where I misread the frequency of a medication. I gave 800 mg Magnesium PO every one hour for three doses instead of every 8 hours for three doses. The mag was 1.5 initially. No harm ended up resulting and even I redrew the Magnesium hours later the level was 1.57 and when I redrew it at the end of shift it was 1.70 and I discussed it with the day-shift nurse. I spoke about the incident and self-disclosed my mis”

“New grad Owner doc wants me to RX abx - when not indicated - just to make pt feel like something was done / to not get bad reviews from patients. Would you go along with it? I only plan to be here a year submitted by /u/Inner-Mycologist5632 [link] [comments]”

“Does anyone have a template for a letter for a risk adjustment audit regarding a patient with minimum necessary information? I am working on responding to risk adjustment audits right now and I know that the best way is to use the minimum necessary rule. So far I've found this article to be the most helpful, they suggest putting in the following information: "...may respond by sending PHI which includes results of testing and a summary of the diagnosis, functional status, treatment plan”

“EMS: “80-year-old male. Altered coming from nursing home. Baseline unclear, possibly dementia” “Reset the counter” I think to myself. Start going through the usual. He was pleasant, smiling, cooperative, but clearly confused. He could answer some simple questions, but his responses were inconsistent and his attention wandered. Go over the basics—order labs, imaging, review chart/history/meds, etc... We know this routine all too well. Contact the facility. Turns out his children had been visiting”

“The only thing that recent patient had was mag and a pit bolus no seizure prns either. The one who needed platelets just had mag I believe. Now if either of those patients had sepsis needing levo or needed airway protection then I would understand but I’m just scratching my head with the ones I’ve had to take care of.”

“For those who didn't see the last post I made it was basically how do you go about it when 2 consultants have different management styles for the same patient when the diagnosis is potentially different and it was between anaphylaxis Vs paroxysmal vocal cord dysfunction. Long story short - she represented whilst I was on shift today. No trigger again, maybe having some reflex recently, hoarse voice and difficulty breathing. No other signs of anaphylaxis and all obs stable with sats 100%. Thi”

“Chief complaint was wife found him on the floor lethargic and weak and diagnosed with AMS and UTI, he was 70 years old too so it could’ve been the UTI but his hallucinations were pretty severe, he would shake in fear almost like he was falling down and then grab things that weren’t there and eat them and also try to get out of bed and take off his gown and IVs. He didn’t have an elevated etoh but he did have a history of alcohol abuse but he hadn’t drank in years per wife. He also had history of”

“Looking for some insight from cardiology or lipid management experts because this case has been bothering me. I’m an experienced primary care PA. I recently saw a 68-year-old male with a history of CAD s/p CABG who presented with significant bilateral lower extremity myalgias. As part of the workup, I ordered routine labs including a CK, which came back in the 500s. Given his symptoms and elevated CK, I had him hold his atorvastatin for two weeks. His myalgias completely resolved after stopping”

“My girl Cara was just diagnosed with CKD 3 months ago and ever since she’s been steadily declining. She didn’t become anemic until about a month ago. She’d been struggling a bit more so I took her in thinking I’d be able to leave with some medication or supplements for the anemia. In my brief google search it looked like there were a lot of options. However, the vet said she only had about a month left (when discussing quality of life). She said she might have longer if we were willing to let he”

“Hi everyone. I just want to start off by saying that I realise to a lot of you this will seem incredibly basic knowledge and baffling as to why I’m even making this post. I have made similar posts before but I don’t think I was wording them quite right. To make a very long story short, I’m from the UK and had some pretty unique placement experiences which meant I got near to no hands on experience with malnutrition patients at Uni- this included patients on ready made bottle feeds/ powder feeds”

“So I have been fighting Humana over the most ridiculous denial for a nuclear stress test for a patient and I seriously have no idea how it keeps getting denied and I've just kept pushing so they have offered me to do something called an administrative law judge hearing. I am 100% doing it. I've never even heard of this until today. I was told I'm going to speak to a judge who will determine if the service should be approved. I think it's crazy that I'm speaking to a judge abo”

“Went into l&d with the most horrendous back pain at 31+6 7pm-ish. I was found to have gone from 1cm to 4. They immediately admitted and did steroids and magnesium, procardia, antibiotics, and fluids. Around 3am at 32 weeks (following morning) I was found to have dilated to a 5 despite all of these measures. Well, its now been almost 24 hours and no change from 5cm. They aren't sure when I will deliver but doctor wants to keep me in hospital until then or until 34 weeks. I'm still on”

My jaw actually dropped reading that.

“That is horrifying omg! I responded to another poster, I have more questions and I wonder if you may know, if you can read my other comment?”

Omg!

“A nurse drew up 3 ml of short acting insulin instead of three units. Critical lab result was not caught by lab or the preceptor RN. Patient expired.”

“Well that is lowkey horrifying, but also if you happen to know, I have heard of lidocaine IV given during ACLS. My understanding it is kind of phasing out and doesn't have a lot of support, and I have only seen it maybe once. If an anesthetic in the bloodstream can cause this, what is different about lidocaine? Also, I'm annoyed that this was never brought up the entire time I've been ER. Like we get malignant hypothermia training (which is also a rare condition I assume like LAST?)”

“The reports on kids are always so insanely over the top. Was sending out a kid with the most simple, small and closed fracture once and got asked if he’s autistic, if so how “violent”, and what his specific tics are….kid was 5 and chillin watching iPad lmao”

“I'm 32 weeks and was referred to an MFM for high blood pressure at 18 weeks within the same medical network. Since then I've been following up with the MFM and taking my blood pressure at home. It's normal at home but always elevated at appointments--especially the first reading. Following the first MFM appointment, the referring doctor told me to not schedule an appointment with them until after the follow-up. We've now had two follow-ups. I haven't seen the referring doctor”

“Intern here, a very common pt concern and question is whether they can eat or not. Other than the potential to undergo surgery, I am not really certain when a patient can, and cannot, have a turkey sandwich. Truthfully, not certain which procedures they definitely cannot eat before, and which do not matter. Any hard rules or guidelines I can employ? Edit: this appears to be a pretty debated topic; enjoying reading all the answers though submitted by /u/ThrowRATest1751 [link] [c”

“Case here: https://expertwitness.substack.com/p/thrombotic-thrombocytopenic-purpura tl;dr Lady with lupus comes in with shortness of breath and weird neuro complaints. ED doc orders CT head, CXR, EKG that were reportedly unremarkable. Road test done, patient briefly desats to 80s but is discharged anyway. Bounces back, labs show severe anemia and thrombocytopenia. She’s admitted to ICU but codes and dies. Lawsuit goes to bench trial, judge awards $3.3 million. IMO not getting labs in a lupus pat”

“Transferred 80 year old woman with graves disease. She already had surgery on her other eye. She was pooping and pushed down so hard her eye popped out and was bulging out past her eyelid out of socket. She starts screaming. She is in the last stages of dementia. She had dug poop from her butt, was covered in it, and was clawing towards her eye trying to fight me because I held her arms away. I had another girl with me who i told to hold her other hand, and with my free hand in shoved her eye ba”

“Dude was fine on paper. Labs okay, vitals good, but just kind of weird mentally at times. I told the resident that I didnt know what was wrong, but something was. Resident comes and sees the patient, everything seems fine, resident shrugs at me. Later I grab the charge, who humors me. Run some ABGs, those fine too. Whatever, can't treat on vibes. Go home in the morning, pt downgrades and transfers to the floor. Show up for work the next night, patient gets wheeled in at start of shift, intub”

“we had a young 20 something with a trach who was suicidal and always had a 1:1. She had horrible asthma and someone along the way (a doctor) convinced her to get a trach. She was a former nail tech. She would be in the hospital for months sometimes, bored out of her mind and pitting employees against each other for entertainment. She was on a ridiculous dose of IV solumedrol. I gave her a tablet to use with my manager’s permission. She logged onto Facebook and reconnected with some friends she m”

“I’ve had to take admissions without IV’s that were NPO and had fluids and IV meds ordered. It unfortunately happens. Our IV team was an outside vendor and only worked from 8am to 6pm, so that was not an option. I did love walking over and bragging a bit when I got a line in them though. 😅”

“Questions over questions over questions. After being admitted to the hospital twice because I suffered 8 „anaphylactic shocks“, where I had 1x 24.05.; 4x 26.05.; 1x 27.05.; 1x 6.06. and another one 28.06. Two „shocks“ were severe with BP being 80-45 and another where oxygen lvls dropped to 63% (idk how that’s just what bloodwork said), in all events epinephrine was injected due to almost being unable to breathe at all. we have been wondering whether I have MCAS, since I’m in the middle of being”

“So for context this is my second pregnancy and I'm almost 30 and in good health. I'm currently 36+5 weeks pregnant. My entire adult life my blood pressure has sat right around 100/60. Since around 25 weeks something has just felt off about this pregnancy. The Drs at my practice always say everything looks great and I'm fine and to not worry. At 34 weeks I started having contractions but not close together about every 10-12 minutes. I also started having sudden swelling, headache, and”

“Every med combo will be different for every person, so I can't really give you advice on that. I was in crisis for like 6 months this time. A few years ago, I had an attempt and landed myself on the psych ward, and was in crisis for a good 6 months then, too. I'm diagnosed with bipolar disorder, so I oscillate if I don't keep myself in check. I take it hour by hour. A friend of mine gave me advice that really worked. Think of one glimmer, and one darkle a day, and focus on them. A gl”

“Dear all, I have an insanely low pulse 10 days post partum. Just spent 3 days in hospital and they found nothing. Been discharged. Kind of freaking out after my pulse dropped to 35 at night. Did anyone else have this? My heart is fine but slow. submitted by /u/Traditional-Past9330 [link] [comments]”

“I was just thinking about this so wondered if any of you guys could relate- Had a patient who was getting below the knee amputation the next day. Gross, wet gangrene halfway up their calf. They asked me, very sincerely, if they would be allowed to keep the leg after the surgery because they were dating a taxidermist. They did not go home with the leg souvenir. submitted by /u/LynchPinne [link] [comments]”

“I was diagnosed with fibromyalgia about four years ago and recently started seeing a cardiologist because my primary thinks I might have POTS. My cardiologist told me doing a tilt table test was pointless and we just needed to treat symptoms. This has been working so so, but part of me thinks I need to get a second opinion. On another note, I have difficulty pacing and managing my symptoms, and after I started to get more and more frequent dizzy spells, it’s gotten even harder. I’m a mother of 2”

“Not sure if this is the right sub for this question but i thought y’all should see this at least. last night we get a patient for complications related to a foley he had placed during a bladder procedure (no idea what procedure it wasn’t my patient). then nurse was irrigating his foley and this came out. what in gods name is that? it was almost spongy but also hard but had give? def not a kidney stone (obvs? maybe?) maybe like an inch long. i’m thinking a piece leftover from the procedure ? but”

“So I had NS running at 75 on a patient with zosyn y-sited into the NS. The zosyn was OFF and had been off before I ALSO y sited Doxycycline to the NS. IMMEDIATELY the IV infiltrated. Did I do anything wrong? I knew doxy and zosyn were not compatible but the zosyn was off. I’m kinda feeling like shit cuz the patient was in a lot of pain but part of me feels like I did absolutely nothing wrong since the NS was completely fine b4 hand. submitted by /u/Unlucky_Painting_173 [link] [”

“Are you guys routinely giving lytics for massive or submissive PE’s? Or are you calling IR (or your PE response teams) for thrombectomy and starting on heparin? And if you do give lytics will your interventionist still do the thrombectomy? submitted by /u/exacto [link] [comments]”

“New pt in LTC. Severe PCM, stage 4 pressure injury, h/o larynx cancer/cachexia, CKD (GFR has been in 40s) Current wt 89# BMI 14.8. UBW 116# Facility wt hx: 6/30 89#, 6/28 92#, 6/21 99#, 6/5 111# (2+ pedal edema on 6/5) Prior wt hx: 5/29 96#, 5/10 95#, 12/22 119# Have gone from 1500kcal, to 1800kcal to now 2000kcal. Has been tolerating all feedings. Started with continuous and now on bolus feedings, has tolerated all. Past week no interruptions noted, confirmed correct formula and volumes being g”

“First: I know the ER isnt for chronic conditions (congenital smas), but when my chronic condition starts creating acute emergencies, something needs to be done. Especially when im expelling my meds every day, food, water, and cant keep my blood sugar up at home and outpatient wont do anything The admitting doctor was incredibly nice, they gave me fluids and ordered an oral trial, diagnosed failure to thrive in adulthood because im losing weight rapidly and cant get proper intake. She also did an”

“Saw a patient yesterday who has the classic “chronic fatigue” and “chronic joint pain” with a negative million dollar work up. This patient has been seeing a functional medicine clinic, which normally I don’t care about, but yesterday a switch flipped. This patient believes they have “chronic Lyme disease” despite never being diagnosed with Lyme disease and any testing being negative. We discussed possible fibromyalgia, but of course they want to “get to the root cause.” So they’ve been seeing a”

“Hi guys, I would like to see what everyone thinks of this. I’m a paramedic that primarily works in a rural area. My AEMT partner and I responded to a high-mechanism MVA that resulted in one of the passengers being a trauma arrest. A mid-sized sedan T-boned an older 80s coupe on the passenger side at approximately 55-60MPH. Both occupants of the coupe were properly restrained at the time of collision, but the passenger was pulseless and apneic at the time of contact. After a significant extricati”

“There was a rapid on my floor that I went to help with. The patient was going back and forth between SVT in the 180s and stable Vtach and completely asymptomatic. When in Vtach the MD running the rapid ordered 1mg epi given. No other meds were given up to that point. I was surprised to see them jump straight to epi rather than adenosine or another antiarrhythmic, and the house sup asked why not adenosine at the time, to which the MD said "it's VT, adenosine wouldn't be effective&quo”