Many of us struggle with access issues. I am getting burdensome inquiries frequently
regarding whether a patient scheduled far in the future should be seen
sooner. Two such recent issues were
resolved as below.
1) Message to me: 7 year
old patient has been referred for developmental delay, leg weakness and arm
weakness.
Mom says he has always been at least a month behind in
gaining skills. Has difficulty riding a
bike, going up stairs. Fatigues easily and legs hurt. Mom said his calves
(bilateral) hurt, are always tense and are “huge,” beginning to walk on his
toes, intermittently. When climbing stairs does not alternate feet and has to
“pull” himself up using his arms and the railing. Trips and falls a lot. Has not seen any specialists previously. He has been scheduled into your next available
clinic on 2/6. Please advise whether this timing is appropriate.
Response: Has this
patient ever had a CK (creatine kinase, in the past often abbreviated CPK)
checked? If not, it is a simple blood
study and could be very important.
Message to me: No
previous labs. I have a call in to the clinic to request the primary to have
labs done. I’ll specifically request the creatine kinase, CPK, anything else
you specifically would like requested?
Response: No, just
that one lab.
Two days later, message to me: You recommend the patient have a CK lab done.
The lab called with the abnormal CK value of 24,506.
He will see our neuromuscular specialist.
2) Almost 12 year old being referred for possible seizures and
dissociative disorder. Staring off into space and does not respond,
some tongue biting. Mom would like to
be called at work today. Episodes started over 1 year ago. She had some major issues going on in her
life so they thought it was due to that. Episodes are happening at school. In the past she usually blamed her episodes
on when she was in trouble. Mom said episodes
seem a little different now. Pt.
stares off into space, starting to chew on her tongue. Lasts 20-30 seconds. Not sure how often they are happening at
school. Most of the time she will come
out of it when they call her name. Happens
3x/week at home, snaps out of it when mom touches her shoulder. Last week her eyes were twitching. Stops
activity, stares off into space but resumes activity immediately after episode
ends.
First available appt. with neuro NP is 3/29.
Paged Dr. Breningstall.
Per Dr. Breningstall, he would like pt. to have an EEG done
initially. Clinic appointment can be then be
scheduled based on the results.
8 days later EEG done, demonstrating absence seizures. Patient begun on ethosuximide. Appointment pending.
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