Dishing out a well-deserved comeuppance to a haughty egomaniac is a temptation that few people can resist. Given the difficulty, or shall I say impossibility, of a physician being correct 100% of the time, most physicians have learned the value of humility. Some have not, though. I previously worked with a fellow who had an overblown sense of his medical ability. Apart from his misdiagnosing some critical patients, he would sometimes humorously misdiagnose a case that should have been obvious to a second-year medical student. For example, one hapless fellow, who was taking Haldol^®, came to the ER one day (years before the advent of Viagra^® and similar drugs) saying that his penis had shrunk four inches and that there was “no life in it.” The doctor diagnosed him as having “chronic impotence” and referred him to see a urologist. For what? An implant? That was mistake #1, because this 31-year-old man was not a candidate for an implant—almost undoubtedly, his impotence stemmed from his use of Haldol^®, which is known to produce this complication as a side effect. This fact is something that every physician should know.

Mistake #2 was when the staff photocopied the chart, writing on it in bold print, “Our chart of the week! No joke.” They posted this chart in the ER conference room, amused with the notion that someone would actually go to an emergency room for such a problem. However, the joke was really on the ER doctor, because if a patient is in the ER—justified or not—he should at least receive a reasonable diagnosis, explanation, and referral. What this patient needed was for the ER physician to explain to him that his impotence was probably caused by the Haldol^®, and that his personal physician would need to consider changing the medicine. A urologist is not the one to make that determination. Haldol^® is a drug used to control psychotic behavior, so the referral should have been to the patient's family physician or psychiatrist.

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