It’s a Duck

You know the saying, if it looks like a duck, acts like a duck, quacks like a duck, it’s probably a duck.  I apply this to C.Diff.  If it looks like it, smells like it, comes as frequently as it, it probably is the Diff.  Simple right?  But what I never understand is the thought processes our highly trained resident physicians contort themselves through to diagnose the Diff.  Like I’ve said before, it seems like they have a quota to fill for C.Diff tests in a month and even if the evidence is such that the odds are pretty fucking low that it is the Diff, they’ll order it anyway, along with the resulting isolation.

Here’s what I mean.  Patient has been on antibiotics for a couple of days, notes cramping in their lower abdomen.  Mr. Resident orders stool for C.Diff thereby initating the cascade of events including moving the patient to a private room.  So what’s the problem?  The patient isn’t pooping.  Nothing.  Not a drop.  Usually with C.Diff they’re like a salad shooter, spraying infectious diarrhea across the room (OK, I’m exagerating…kind of).  Not them.  They’re constipated.  So the doc orders a suppository.  Just to get a sample.

Does this seem strange?  I know there are times when the Diff doesn’t cause CDAD, but more times than not, it ain’t the case.  It’s become my favorite order, a suppository for stool sample to screen for C.Diff.  When does it stop?

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2 Comments

  1. Yup, it doesn’t make sense.

    I also find it a waste of time to check for C-diff when a patient has chronic loose stools due to say, short-gut syndrome, and she has no other indication that she might have a C-diff, she is not even complaining about the loose stools, she’s not on abx, the reason she’s in the hospital has no connection with her bowels, etc. etc.

    Reply

  2. I used to work at this medical gastroenterology ward here in Norway some years ago, and experienced the exact same thing. Doesn´t make sense at all. And very annoying. But it really must be worse for for the patients. I remember some patients who never got rid of the Diff, and as a last resort they had feces from their relatives put into their ventricle via a scope, a so called feces installation.. Oh my, oh my..

    Reply

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