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Thinking about thinking.

Article Excerpt
A homeless man was seen at a private hospital complaining of double vision. A physician who first saw the patient noted some nystagmus but no obvious eye movement abnormalities or "focal findings."

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Being homeless and having nystagmus, the patient was felt to be intoxicated and an alcohol level was drawn. When it was found to be zero, a neurologist was consulted. The neurologist noted vertical nystagmus, slight impairment of lateral gaze, and upon walking the patient, pronounced midline ataxia. The patient was diagnosed as having acute Wernicke's disease and made a complete response to thiamine.

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A young woman was seen in the emergency department agitated and crying with a complaint of tight limbs and inability to keep her neck from spontaneously extending. She had been ill with the "flu."

A diagnosis of hysteria and anxiety was made. Another physician, passing by the room immediately recognized the posturing and elicited a history of past prochlorperazine use for vomiting. A diagnosis of acute dystonic reaction due to phenothiazine was made, the patient responding quickly and completely to anticholinergic medication.

Virtually every honest medical worker will admit to having stereotyped patients as "hysterical female," "drunk," "homeless," "secondary gain," "malingerer," "crock" or "frequent flier."

Those who say they would never put such a label on a patient...

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