50ish hypertensive hypercholesterolemic male smoker.
Seen by another provider 2 weeks ago. Advised to go straight to the ER for shortness of breath, tachycardia, weakness. Told her he'd be driven there by his son, decided not to go, "I felt too sick".
Called a week ago stating he passed out at home. Advised to go to ER. Refused.
Called yesterday stating he still felt weak and dizzy. Advised to come to office immediately for appointment or to go to ER. Said he couldn't come in till today.
Appointment with me today. Hypotensive, tachycardic, normal pulse ox and EKG. Complaining of weakness and dyspnea.
I assumed my "Fear of God" voice (which I pull out on rare occasions only) and told him that he may be suffering from any number of conditions, not limited to a heart attack or blood clot in his lung, which was potentially life-threatening. And as much as I would love to be able to work him up and treat him in the office it was not possible. And that he must go to the ER for appropriate care.
I stepped out so that my nurse could do his EKG.
His comment to her, "Gosh, is she always so grumpy?"