S.M., a 30 something nurse, left a message for me complaining of diarrhea. I asked my usual questions... she had non-bloody diarrhea, low-grade fever, no significant abdominal pain, and no history of exotic travel. Her symptoms were suggestive of simple viral gastroenteritis, and I advised fluid replacement and Imodium.
Next, S.M. asked for something for her "yeast infection."
I immediately became concerned. There is an application of "Occam's Razor" that relates to the practice of internal medicine. Very simply, Occam's Razor is the tenet that the simplest solution of a puzzle is the most likely. It’s application to medicine, is that there is usually a single diagnosis causing multiple symptoms, as opposed to multiple diagnoses causing the multiple symptoms.
Back to S.M. I became concerned that a single diagnosis might be responsible for both her diarrhea, and vaginal symptoms, as opposed to her simultaneously having both viral gastroenteritis and a yeast infection.
I inquired why she thought she had a yeast infection. She replied "vaginal redness."
I inquired if she was menstruating. "Yes." Tampon? "Yes."
I instructed her to immediately remove her tampon and proceed to the emergency room.
Upon arrival to the emergency room her blood pressure was 60/__. The application of a simple tenet, Occam’s Razor had saved her life. Instead of her having viral gastroenteritis and a vaginal yeast infection, she had toxic shock syndrome causing her diarrhea and rash. Admittedly, the rash associated with toxic shock syndrome is usually a head to toe redness. Unfortunately for my colleagues and I, patients don’t always present with the "usual" symptoms.
Now the lessons:
- Only by the grace of God go I. It would have been very easy for most physicians to miss this diagnosis. This case reaffirmed my faith in God.
- Your best medical care is in the office. Period. It is not the most convenient or inexpensive, but it is the best care. An experienced physician can tell in a glance if someone is very ill. Even if I didn't put all of the pieces of the puzzle together, a simple blood pressure would have indicated the gravity of S.M.'s situation.
Never succumb to the temptation of soliciting advice from a physician outside of the office. You're going to get LOUSY care, and you place the physician in a medical legal conundrum i.e., he or she becomes liable for their advice, even though it was based on very limited information.
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