auto shop

Family Physician Leaves Medical Practice to Work in an Auto Shop

  • 929

auto shop

If your doctor worked at the local auto shop, this is the kind of note s/he would write after looking at your car:

Chief Complaint:
“Hard to start”

History of Present Issue:
Dart is a 46-year-old green Dodge with a 2-week history of difficulty starting.  She was seen 2 months ago at Outside Service Center for a routine oil change and was running well at that time.  In the past 2 weeks, however, she has been getting harder and harder to get going.  She has not changed her gasoline rating recently.  Starting difficulties are not affected by wet weather or cold temperatures.  A new battery was installed approximately 1 year ago.  Her engine sounds like it is turning over very weakly and lately only a “clicking” sound is heard when the key is turned.  Lights come on normally.

Past Mechanical History:
Tune-up 2014

Family History:
Electrical problems in older model years.

Social History:
Smokes occasionally when cold; lives on the side of the road in southeast part of town.  She was driven hard when she was younger but is generally sedentary now (although still a known swinger).

Review of Systems:
Negative except as noted in HPI.

87 octane
Castrol hi-mileage
Transmission fluid (generic)
Michelin radials x 4
Prestone Anti-Freeze
DieHard Battery

Middle-aged vehicle appearing older than stated age
Body: grossly intact; rust and peeling paint noted
Glass: crack across windshield
Drivetrain: 3-speed manual
Tires & Wheels: whitewalls intact throughout

Diagnostics Exam:
Lights: working, bright
Horn: loud
Ignition: none, clicking only
Battery: terminals with minor buildup, 575 CCA
Radiator: anti-freeze WNL
Tailpipe: exam deferred

Assessment & Plan:
Older, well-worn vehicle with symptoms consistent with starter failure.  Differential diagnosis includes: battery failure, however it tested OK; electrical failure but operational lights make this less likely; distributor failure, but a tune-up 2 years ago including new points & plugs makes this unlikely.

Consent for starter replacement was obtained, to be performed this afternoon.

Procedure Note:
Patient was taken to the mechanic’s bay.  Before the procedure, a “time out” was held to verify the patient’s name, VIN, and license plate number; tool counts were completed and the operative site was confirmed.

The hood was opened in the usual fashion and the engine was visualized.  The starter was located in the expected position.  After disconnecting the battery, the electrical and ground connections on the starter were removed in the usual fashion.  Bolts were lubricated with WD-40 and removed with a 3/8 SAE socket. The failed starter was removed en bloc, and a new starter (Duralast Model #17466N) was installed in its place.  The new starter was secured with 3 bolts tightened to 30 nM each.  Electrical and ground connections were made.  The patient was started and ignition was noted promptly.  The hood was closed in the usual fashion.  All tool counts were correct.  Estimated fluid loss was minimal.  The patient was returned to the parking lot in satisfactory condition.

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