DIET 1/2024 COMMUNICATIONS COLLECTIONS (Thu)

From WhatsApp groups feedbacks

1. Myotonica dystrophica counselling

She has a baby 4 months ago which was diagnosed with MD.
His brother’s age is 7 and doing well.
Her mom had cataract at age of 52. She is asymptomatic apart from mild stiffness.
Her sister is fine and has 2 kids with no symptoms.
Task – council and discuss further.
Concern – I gave the disease to my children and …

2. H/O TIA and AF – given warfarin, stable for 6 years - developed anaemia - treated with
iron and improved – further colonoscopy and biopsy confirmed ascending colon cancer –
CT CAP was negative
Discuss – refer to surgeon
Concerns : - mother died and he will not go for surgery
- Stoma
- Stroke if stopped warfarin

3. DM with hypoglycemic unawareness on metoprolol as well

4. PCKD – BBN and further plan, (genetic explanation), address concerns and prognosis of
the disease

5. Patient was Parkinson with pneumonia and admitted in ward for 3 days now, confused and
dizzy as anti-parkinson medications were missed during hospital admission.
Improved so missed dose of anti-parkinson medicines and now drowsy
Concerns like error

6. Pheochromocytoma was same repeat, Delayed diagnosis

Patient has hypertension and attending GP clinic many years, taking medication, BP
controlled, patient asked to do more investigation, but didn’t arrange more tests, one year later,
GP referred to hospital for more tests, Urinary metanephrines and MRI scan done found
Pheochromocytoma, PET scan , adenoma is confined to adrenal.
Delay?
7. Hepatitis B scenario

8. MRSA – leg cellulitis was treated in hospital with IV A/B, junior dr changed IV cannula
without gloves and he got MRSA infection in arm as well, So dealing with angry patient

9. Sulphonylurea overdose – DAMA

Young lady took gliclazide
Was managed with dextrose
Mx team decided to take mood dr review for her
She was angry and was will DAMA as mood dr was involved without her consent

10. Angry patient, Son was concerned regarding steroid induced psychosis i.e. steroids was
given in suspicion of GCA, However, the consultant proven that it’s not the diagnosis and
patient was stopped from steroid and then admitted to the hospital

11. SLE diagnosis, piano teacher with arthritis

12. Son of a patient who has CA bladder, now presented in ER with drowsiness and deranged
RFTs, treatment nephrostomy planned

13. Angry daughter whose father developed amiodarone associated lung fibrosis

14. Stroke patient done thrombolysis, found to have AF and started on anticoagulant. Now,
came for F/U regarding his condition, To manage risk factor and for prevention of stroke.
Pt BP good, no DM, LDL good, still got some homonymous quadrinopia.
Patient concern – Can I drive? - I said, still got vision problem, not safe yet.

15. Oncology pt? /

16. DNR on 90 years old lady found on floor and got ICH. Neurosurgeon – no active
intervention and patient is dying. Talk to the daughter.

17. Counselling with son, mother developed AKI with gentamicin due to medical error
18. Penicillin allergy, given penicillin and now she has pneumonia, delirium and error

19. Medication error – Known DM came in ward with pneumonia. Dr prescribed short acting
insulin was written 20 units twice a day of short acting on got hypoglycemia, 3rd post
admission day got that at home mixed 20 units twice a day, pharmacist told he should be
taking mixed rather than short acting.
Concerns – what could happen, what will be long term effects

20. K/C/O old came with pneumonia already on maximum treatment, consultant decided he is
already on oxygen and maximum treatment, so tell patient about DNACPR and comfort
care, premorbid he was bed bound at home and maximum oxygen support as well

21. Advanced Parkinson’s with dementia, H/O recurrent aspiration pneumonia, SALT
assessed swallow issues, no oral feeding, primary consultant not opting for invasive
procedures, nephew wants to know further options for enteral feeding.

22. RA on MTX, now with MTX induced pneumonitis, PFT – mild restriction, currently on
steroids and worsening of RA after stopping MTX. Patient adamant on restarting MTX as
had benefit with that.
Dr start him on steroid, he wants to stop steroid bcoz afraid from side effects.

23. Uncontrolled DM not willing to take insulin injection

24. 78 years old female with CAD H/O now Angina at rest, CABG planned and patient
refused for it as explained by the interpreter. Son insisting on signing the consent and
asking if he can explain this to the patient about instead of interpreter and was angry, why
we talked to the patient about surgery without involving him first.

25. Advanced COPD, DNR – patient had COPD with chest infection and recent decrease of
exercise tolerance, Discuss DNR with daughter

26. AF, TIA – counselling about anti-coagulation

27. Lost report of FNA in advanced cancer, Medical error

 28. Angry patient, Lost of biopsy, have suspicion of cancer, refuse to do other biopsy

29. Old age patient but competent, she had weight loss and iron deficiency anaemia and
suspected to have cancer, need workup but after discussing with the patient, patient
refused to do any procedure and agreed only in taking iron tablets. Discuss with the son.
The son asked to do investigation

30. Palliative and DNAR

31. BBN to the son, his father has brain tumour and consent for MRI for further assessement

32. Palliative care for interstitial lung disease

33. Drug error – Patient 30 years admitted with pneumonia 2 days back and 2 h back had
seizures because the epilepsy drug was missed, he is known epilepsy and well controlled
since years and concerned as he works as a driver.

34. K/C/O UC patient, student, got diagnosis from biopsies 9 months ago, have been on
mesalazine, symptoms getting worse, ESR high, opens bowel more than 6 times/day, have
impacts on school life, Counsell for steroid.

35. Old patient, candidate for ICD, convince him and check competency

36. 45yrs F recently diagnosed T2DM

with High BMI and has had GI side effect on metformin. She currently has osmotic diuresis
and blood glucose not well controlled.
Discuss: further management regarding her DM and rationale for her bariatric surgery.
Concerns:
I am frustrated, people are looking down on me
I need bariatric surgery

37. 37 yrs physiotherapist recently joined the stroke team for the last 3 months admitted with rt sided
upper and lower limb weakness , examined by different doctors but the finding are not consistent with each
other , CT normal , MR scan done she declined to be informed about the result when the registrar attempt .
One of the nurses informed her that the doctors believe that she is faking her symptoms , now she is upset
and requested to see u to now about the result and to explain for her her symptoms , the diagnosis made by
the team is functional weakness .
Inside she disclosed that she is very stressed at work and at home has financial problems as well .
Concern : _ am I faking my symptoms
_ what you will do for me
_ will this weakness resolve
38. DNAR (Ca breast with metastasis)

39. Counselling regarding Warfarin