Descriptive analogies are often recorded at triage as a brief overview of a patients presenting complaint. For example the recording of central crushing chest pain on the triage screen would lead the astute and observant attending physician to assume the patient to be suffering a myocardial event, rather than a persisting altercation with a Grizzly.

When you hear hoofbeats, think horses, not zebras

Dr Cox in Scrubs “My Balancing Act”

In most instances symptomatic analogies are interesting, useful and replicable across emergency department attendees; occasionally they can be misleading (when limited by the patients lexicon) and rarely, descriptive analogies are non-comparative i.e. factual.

For example, burning pain post urination is figuratively associated with dysuria (painful or difficult urination). Dysuria in the emergency department setting is most commonly due to a urinary tract infection and associated inflammation of the bladder (cystitis), kidney (pyelonephritis) or urethra (urethritis).

Rarely, however, the patient is in fact describing a non-analogous symptom and their penis really is burning post urination.

Burning Pain post urination

Learning points:

• To expect the unexpected shows a thoroughly modern intellect – Oscar Wilde, An Ideal Husband
• Never pee on an electric fence….
• Never use excessive short-wave diathermy

Electric Fence

http://www.youtube.com/watch?v=r1ahQrQmNDI

Don’t whiz on the electric fence

Life in the Fast Lane Medical Blog - Emergency Medicine education blog