October 22, 2012
Yesterday’s article dealt with the importance of listening to your patient and how the doc’s ear is his most important diagnostic tool. Today, I want to address the importance of believing what you hear. The second most important diagnostic tool is your brain! Once a physician hears his patient’s story, he has the choice of believing it, even if it is illogical, or dismissing it in favor of a more conventional interpretation.
Yes, patients often tell you what’s wrong with them and, often, their diagnosis is highly unlikely or even impossible. Thirty years of practicing medicine has taught me that the “impossible” is possible and some of my best diagnoses have been made because I choose to believe what my patient told me!
In my second year of residency, I received a call from the floor nurse telling me that Patient Y was asking for Last Rights. Patient Y was scheduled to go home in the next few days and had no reason to die. I went to the floor and reviewed her records and then examined my patient. Patient Y was resolute in her opinion that she would not see the sun rise despite my confident reassurance. Patient Y died that night. Her autopsy revealed a tiny cerebral aneurysm rupture as the cause of her death. I never forgot how incredulous I was at Patient Y’s insistence that she was dying and how healthy she was at the time of her death.
Choosing to believe your patients when their concerns are unrealistic is not easy. Yes, I’ve run a great deal of tests that turned out to be unnecessary in order to disprove my patients’ diagnoses; and the majority of time, my patients concerns turn out to be truly unfounded. When my patients’ seemingly unfounded concerns turn out to be real, it reinforces by ability to believe in the impossible and often saves a life.
“Doc, there is something wrong in my head! No, I don’t have a headache. No, my memory and speech are ok.” “No” was her answer to every question, yet she firmly stated there was something she could not describe that was in her head. She was not crazy! She, too, had an aneurysm and it was successfully clipped. Twenty eight years, later she is doing fine. Believing what your patient tells you may be hard, but it is vital to good care.
In today’s cost conscious world, believing is discouraged. If the patient above walked into my office tomorrow morning, I would have had to convince an insurance clerk to authorize her CT and would probably have been refused authorization. Trying to meet the requirements of a computer-driven algorithm in order to diagnose a disease process requires more than a belief. And that, my friends, is the problem with today’s healthcare system and is likely to be the major drawback to Obamacare and the herd approach to medical care.
Dr. Segal blogs at www.livewellthy.org