I had the most endearing interaction I think I've ever had today with a patient. He was an extremely polite schizophrenic man who came in because he was convinced his water supply was being poisoned.
Me: What makes you think your water is being poisoned?
Him: Well, my girlfriend, she told me to drink less water. She thinks I have too much every day, so she told me to drink less. I'm pretty sure she poisoned it.
Me: Why would she want to do that?
Him: To get me to drink less, of course.
The logical explanation lies with his past medical history; he suffers from a condition known as potomania - overactive thirst - which can cause significant electrolyte imbalances in the body with too much water ingestion. The treatment is to drink less water; his girlfriend was actually looking out for him.
For a moment, I entertained the fallacy of his reasoning. "Why on earth," I thought to myself, "would your girlfriend poison your entire water supply? This is the schizo talking."
Then, I thought back a couple of weeks. In the middle of a particularly hectic shift I took care of an autistic kid who kept coming up to the physician's desk asking the same question over and over again. "Can I get my medication refill now? Please, I want my medication refill now. Now? Now." I finally lost my temper and snapped, "Listen, kid. I'll get to it when I have the time. Right now I have more important things to do than refill your meds."
I saw the hurt in his eyes and immediately regretted my words. One of our child life specialists who I deeply respect pulled me aside and admonished me. "Zac. He's scared, it's loud in the ER and he needs help. He's autistic and he's already out of his comfort zone. I know you're busy, but don't lose your compassion."
Fast forward to today. "Tell you what, boss," I said, "why don't I do a good physical exam and we'll make sure you didn't get water poisoning?"
"That would be great," he said, "I've been so worried."
I've been reading Cutting For Stone by Abraham Verghese, a physician at Stanford well known for his veneration of the physical exam. Dr. Verghese gave an incredible TED talk about the powerful bond a careful exam creates between physician and patient.
So, finding myself with a few extra minutes in my day, I examined my schizophrenic patient in minute detail. I tested for nystagmus, checked Romberg and Babinskis, carefully listened for the slightest of cardiac murmurs, and checked his ears for wax. And, after a normal exam:
"Good news, I don't think your water was poisoned!"
His response was wonderful. "Doctor, thank you so much. You've put my mind at rest. It was going round and round like a carousel and I couldn't seem to get off the ride."
I suppose a physician's touch - even in a busy ER - is still a valuable tool.