New meth diagnostic tool for ER doctors

Sometimes, a patient’s diagnosis is clear right when we walk in the door. This can be due to a distinctive smell as in the case of rectal bleeding, cyanide poisoning or diabetic ketoacidosis. Other times, you can just tell what is going on by looking, and I would like to contribute the following diagnostic sign to help advance the world’s medical knowledge. If the patient is sitting up on top of the exam room counter, eyes darting around wildly, then the diagnosis is methamphetamine intoxication. I can think of no other reason for a patient to choose to sit on the counter, when there are two other good options, namely the chair, or the gurney. Alternatively, the patient could sit on the floor, or even stand, which makes more sense and is clearly more comfortable than perching on a hard, cold counter top. I have only seen this one time, so I don’t exactly have a body of research here. Nevertheless, I feel the diagnostic accuracy of the “countertop sitting sign” approaches 100%.