A diagnosis from thin air

A resident doctor admitted a patient overnight with a diagnosis of “hypoglycemia” (low blood sugar). Our first question was “what was the glucose level” and the response was “I do not know…… because I did not check”.

Even for the layperson, it would seem reasonable to check a glucose level if you were considering a diagnosis of low glucose. The patient presented with an episode of syncope (passing out) and the resident thought it seemed reasonable to say it was due to a sugar issue.

I tried to be very gentle in describing the appropriate thinking for the patient, including doing a neurologic exam, EKG and basic labs. However, a supervising physician next to me harshly let him know he performed very poorly and could have cost the man his life.

On prior occasions, I have seen this resident provide quality care. I think he must have been overworked and tired.

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