here is something you should know

If you are a health care provider...or a patient...there is something you should know. Even the best among us sometimes misses the diagnosis. 

This week, I'm having dinner with a woman whose breast cancer I missed when I was her physician, twenty-some years ago. She'd come to me saying something didn't feel right to her, but I didn't find anything unusual when I examined her. No lump. No tenderness. No redness or swelling. No enlarged lymph nodes. I recommended keeping a close eye on things to see if anything changed. You see, her insurance wouldn't have covered a mammogram just because "something didn't feel right" to her, so I didn't order one. Sure enough, a couple of months later the lump appeared. All that time lost! I watched as she underwent surgery and radiation. I watched as she lost her hair to chemo. I felt guilty, ashamed, angry. There were no words for the apology I felt I owed her. No excuse for the system that failed her. Thankfully, she came through it cancer free, but still...

"First, do no harm."

~Hippocrates~

I never had a chance to apologize to another patient of mine who died of colon cancer after she presented with a small amount of rectal bleeding. It turned out her cancer was just beyond the reach of the flexible scope I had to use to evaluate her because her health insurance wouldn't cover a colonoscopy for patients like her who were at low risk.

Again, there are no words for what I felt.

"Wherever the art of medicine

is loved,

there is also love of humanity."

~Hippocrates~

Today my BFF called to tell me how her appointment went last week when she saw her orthopedist for a problem with low back, lower abdominal, and LLE pain that have plagued her for months. She has been under the care of her family physician, a rehab. specialist, a pain management specialist, and an orthopedist for for over a year to no avail. Last week I listened to her describe her symptoms again. We went over her history, revisited her X-rays and scans, and discussed the treatment plan that  included chronic opiate use and eight months of physical therapy that didn't help at all. I told her they were missing something. She needed a new set of eyes, as we say, to look at things from a fresh perspective. 

Yesterday her pain became so intense, she went to the Emergency Room. Sure enough, they saw something near her hip on the X-ray they took. A CT scan of the area demonstrated the culprit...a fracture of the pubic ramus that she has been bearing weight on for almost a year! 

A missed diagnosis can be a terrible thing. My cautionary note to providers and patients alike is this:

• Listen to your intuition. 
• Never say never. 
• Fight back when the (health insurance) system is fighting you.
• Never give up.
• Look at the world through new eyes every day.

"Medicines cure diseases,

but only doctors

can cure patients."

~Carl Jung~

jan