A night on call...

Part of a "complete history & physical" of a patient includes the "HPI", or "history of present illness". It is the part of the patient's story that expounds on the "chief complaint", and describes the events that brought the patient to the hospital/doctor's office. The following is an HPI I wrote after seeing a patient on my most recent night on call (Xs used so I don't violate HIPPA privacy rights).

"Mr. X is a 28 year old African-American male with a past psychiatric history of paranoid schizophrenia who was brought to the X Emergency Department by the X Police Department after assaulting a police officer. The patient's neighbors called the police after they noticed Mr. X acting strangely outside of his house and an array of knives wildly strewn about his back deck. Mr. X states that he is on a mission from the CIA to take down the police force of America because they are abusing their power. Mr. X assaulted two police officers, and a taser was used to subdue him. When asked how long the patient has worked for the CIA, he reports "since the year of ham and cheese." When asked to clarify how long that was he replied, "you know, ham and cheese." Patient states he also works for the Japanese government on a mission as a "body snatcher". He reports being employed as an entertainer and being involved in diamond smuggling. When the nursing staff attempted to give him a tetanus shot he refused, saying "I'm a doctor and I am smarter than all the rest of you." During the course of the interview the patient was in four-point restraints. When asked if he has been taking his psychiatric medicines he reports, "I already finished all those." He reports hearing a male voice that gives him his CIA mission commands. Pt denies visual hallucinations. He reports decreased sleep and appetite over the past week. Upon release from the hospital the patient is to report directly to jail to where he will be held on two charges of felony assault against a police officer."

And my favorite chief complaint from that same call night (and keep in mind, these are patients who report to the Emergency Room): "I need to see a podiatrist. My toenails are so long and I don't have anything to cut them with."

Life in medicine in never boring.