Knowing too much

Being a physician is a blessing in many ways, and I won’t bore you with the details.  Getting to this point was a lot of work, but it’s been (overall) worth the effort.

And, it’s a mild curse.  A close relative says “I have a headache” and it’s twenty questions with a lot of exam thrown, in, and a modest desire to get a CT.  Yeah, it’s a non-focal exam, and no it’s not a sudden-onset headache, but if anyone presented to my ED with this headache they’d get a CT before they left.

I expect it’s “just a headache”.


But, I’ve seen too much.


And I know too much.


  1. Interesting; I always thought medical professionals hated being asked for medical advice by relatives, friends, and people at cocktail parties. But maybe that’s because it’s so hard to turn off once you’ve turned it on?

  2. Had a woman, late 50’s, in the ER for a headache. Found not one, but two brain tumors. She had fought the doc on a head CT but he talked her into it.

  3. My wife (the one with the headache) emailed this after I went to bed:

    So today I have a headache, now truly, I rarely complain, but today I did. So Grunt Doc takes note and Rx’s me aspirin. I swallow some and go about my day.

    Today is a busy day. Driving school for the teenager at 8 am, Double header baseball game for the grandson starting at 9 am. My turn for snacks, of course.

    Leave the game to pick up the teen by noon, be back to the ballgame for the closing pep talk. Drive the detoured road ( thank you, Army Corps of Engineer’s) 6 times today.

    Wedding reception tonight across town tonight, (need to look good and non frazzled)…and my sister’s birthday party is tomorrow, expecting 12 for dinner. Still
    have the headache… GD says take Tylenol. Done, took some.

    The in-laws are here and MOTHER is coming to dinner tomorrow. ( note to self …clean under the fridge…) So maybe….. my headache is stress related but Grunt Doc says… “If it’s not better by tomorrow we’ll go to the ED and do an LP and Cat your head.”

    What..It is just a headache..

    I’ll feel pretty funny telling the Doc at the hospital my pain is a 3 and to GET out of the room so I can sleep a few more minutes.

    Grunt Doc sees so many bad things… it is a hazard of the profession , expect the worst. I’ll bet I wake tomorrow feeling great, but if I wake up dead, it will be the
    MI, PE, or several other initial Dx’s he predicts could possibly happen. I’ll keep
    you posted.. Mrs. Grunt Doc

    Oh, and she’s fine today.

  4. TheNewGuy says:

    I had to nip the family medical advice thing in the bud early, particularly for my wife’s family. They were asking my opinion on all kinds of things, including calling me in the middle of the night asking if their daughter’s weird abdominal pain could be appendicitis, etc…

    They were initially quite upset when I declined to assist them with medical device (like I can diagnose a hot appy over the phone… sheesh), and couldn’t understand the ethical problems with it, despite my lengthy explanations.

    They got over it though, and they virtually never ask me anything now.

  5. We’re all aware of the patient/relative and MD “perception gap”: laypersons (and lawyers) think medicine is black-and-white cookbook stuff (yes, they DO expect us to diagnose a hot appy or a brain tumor in a store aisle or over the phone!), while we all know better. There is a great deal of nuance to wading through diagnostic waters.
    Trouble is, though I used to go grocery shopping at midnight to avoid curbside consultations with my patients or acquaintenances, now that I’m no longer in the game I… well…I miss it.
    Time for a tox screen, perhaps?

  6. Grunt: that is so true. When my wife was pregnant I clenched my teeth for about nine straight months. Since I don’t know that much pediatrics it got much easier at that point.

  7. Does “she’s fine today” mean the headache is gone?

    I only ask because of how mine started… Nothing too remarkable. I took some motrin. It was in a very specific location (right parietal), and I’d never had anything like it before. 3 days later, I called up my mom and told her that I had had a headache in one specific spot for 3 days. It wasn’t too bad, but it was starting to grate on me and just pulsating constantly. She told me to go to student health. They thought it was a status migraine, gave me phenergan and naproxen and sent me on my way. But it kept getting worse and worse. And the rest is history. My headache is still here today….nearly 6 years later. Diagnosed as New Daily Persistent Headache. I never really thought my life would turn out quite like this, but hey…it started out as “just a headache.” I remember feeling puzzled when the neurologists would ask me what I meant by “just a headache.” Now that I know more (am now a trainee member of the American Headache Society), I guess my own description of just a headache probably meant a tension or episodic migraine. I just didn’t know this (NDPH) could happen to people. To me, it has a very autoimmune presentation, but not much is known about it to date, other than that it is the most treatment resistant of all headache types.

    I guess it hasn’t been all bad. Everything I’ve been through has taught me a lot of patience. I started to eat better and sleep more. I gave up trying to do 1000 things at one time. I’ve met a lot of great people, and I’ve really enjoyed the work I, myself, have now done in headaches. I’m possibly going to take my pediatric nurse practitioner and work in pediatric headache or at least pediatric neurology.

    Long message – all I really wanted to know is if it’s gone now. I hope so much that it is.

    Take care,

  8. She’s fine. Back to normal.

    And I can relay until the Next Family Illness.

  9. Thanks for clarifying. “Fine” can mean so many different things! :) I’m so very glad the headache went away.

  10. Do you ever get asked for medical advice on this blog? My son is 21 and has had 2 TIAs in the past 3 years. Biological father was grand mal epileptic. Son never seized, but had brief “absences” in school. I was reading about in on Google, and I read that in young people, certain metabolic or hematologic syndromes have been associated with TIAs in adolescents and young adults. Do you know anything about this?

  11. I know enough to tell you the following: Get a good neurologist.

  12. And whatever other specialist(s) you think might help.