Rough and Tumble

Dr. Boss: I want you to see this patient first. The mother thinks her son has ADHD but he is only 5 years old so it is a little early for diagnosis and I wouldn't treat him with stimulants anyway.

Me: Ok.

Dr. Boss: Ask them about family history and such, have her fill out this questionnaire and do a quick physical.

Me: No problem.

(Entering room.)

Me: Hi, I am a medical student. I am going to see you before Dr. Boss if that is ok?

Mother: Yes.

Me: So I hear you are concerned that little Tommy might have ADHD, can you tell me why?

(Before the patient can open her mouth Tommy peaks his head out from under the chair where he was hiding and screams at me.)

Tommy: Hi!! Watch what I can do!

(Tommy proceeds to dance around the exam room and "spin" like a helicopter.)

Mother: Um, well. He acts like this constantly and doesn't listen. He won't sit still. Tommy sit down!

(Tommy ignores her and begins to pull on my stethoscope, asking if he can play with it.)

Me: Not right now buddy, let me talk to your mom.

Mother: I just get so frustrated.

(Tommy is back under the chair now and is pretending to swim on the floor.)

Me: I can imagine. Does any behavior like this run in the family?

(Mom goes on to explain how she has three older boys, and none have ever been this wild. We talk about some other things such as aggression and other authority figures in the household.)

Me: Ok, great, now if Tommy doesn't mind I would just like to examine him really quick.

(I help him up on the exam table and just as I am explaining about listening to his heart....)

Tommy: SMELL MY FEET!! (He lifts his feet in the air and nearly kicks me in the head.)

Mother: I am so sorry!

Me: It's alright, he missed!

(I manage to listen to his heart and lungs but that is about it as he is squirming and won't let me do much else.)

Me: Alright, I am going to talk to the doctor but if you could just fill out this questionnaire.

Mother: I already did one! Please, show the doctor!

(She has indeed filled out three pages of questions about Tommy's behavior. I show Dr. Boss and report what I observed. He says Tommy might be showing some signs of ADHD but also might improve his behavior once he starts school and is in contact with more authority figures. I wish that mother the best of luck!)