A 67 year old man presented with increased sleepiness.  3 days prior to the admission, he collapsed in the garden, witnessed by daughter. He attended A&E and he was discharged on the same day with head injury advice. Since then, he had been on increased sleepiness even in day times. Wife stated that he fell into sleep while talking.

He stated that he had a 6 month history of headahce, for which he had been seen by neurologist for headache with once a month follow-ups. Imagings had been done. Diagnosis was not conclusive. It was suggested  ?Trigeminal neuralgia.

So I put the presenting complaints as

1.    Headache for 6/12
2.    Increased sleepiness for 3/7

My consultant was not convinced my statement. He wrote down in his post take ward round section “admitted with increased sleepiness”

It is true. In fact patient did not come to hospital for headache, but for sleeping issue. His headache has been already under the management of neurologist even though recent issue could be related with previous issues. This consultant is very particular. His documentation is awesome. (He has got a unique hand writing style as well)

What a coincidence! Next day, A&E middle grade doctor referred me a young lady with toothache. It was found out that she took 10 grams of Paracetamol in 20 hours prior to admission. Toxic base suggested that paracetamol more than 150mg/kg in 24 hour is toxic level in non-high risk group. Her figure is 166 mg/kg. A&E happily started parvolex. Interestingly,  no management plan for toothache until she was moved to medical assessment unit. Of  course, they just forgot the reason of admission. I prescribed regular codeine and co-amoxiclav. We had to organize urgent dental appointment.

The same thing happened fortnight ago. A young chap was found out paracetamol overdose by A&E, following ear ache. Parvolex was started. When I saw the patient in medical assessment unit, he was in an agony of pain. His ear had full of pus. We had to transfer him to ENT hospital straight away.

Yes, reason of admission is very important. We must not forget to act it.