Monday 17 September 2012

Listen to the patient

It seems these days that X-rays, CT scans, and MRIs have rendered the history and physical examination obsolete.  I've had countless situations when an ER doctor calls me to see a patient based on a CT scan result when they have barely spoken to the patient and haven't even examined him.  Despite advances in medical science, nothing can replace taking a full history, and nothing can replace putting your hands on (and in) a patient.  When I first decided to go into medicine, my grandfather (who was a general practitioner back when they existed) gave me one piece of advice - "Listen to your patients, because if you do 80% of the time they will tell you the diagnosis."  This next story is a prime example.

I received an email from Mrs. L (not her real name) telling me about a horrific experience she had a few years ago.  I've received several stories from readers, and I continue to encourage everyone to submit  stories to me.  But I haven't been inspired to publish one until now:

"This happened about 11, almost 12 years ago. On a Friday night I began having abdominal pains. I figured I was just getting cramps, so I took some medicine and went to bed. The next day I felt fine, and I continued without giving much thought of what might be going on.

The following Wednesday, while at a friends watching a movie, I started having the same pain, but much sharper. I tried to tough it out, and after about an hour I told my friends I was going to go home. I got up and instantly doubled over in pain. My friends were trying to convince me to go to the hospital, and I said not to worry about me, I will just go home. How I thought this was possible given I had a 20 minute drive yet could not walk two feet is beyond me. One of my friends said no, and she went to get my car while the other guy carried me down the stairs and got in the back seat with me.

Once we got to the hospital, I was starting to get worse, and I remember lying on a bench in the fetal position for several hours just crying in pain.  I was finally taken back, and I asked to use the restroom. I went, and there was A LOT of blood.  I was just thinking I got my period, and I'm going to be fine.  I opened the bathroom door, took one step out, and fainted. I was taken to a room, where I waited for test results.  A doctor came in and told me that I was pregnant, which of course caused me to burst into tears (I was 19 at the time).  He informed me that they need to do an ultrasound at this point, so off we went.  I was lying there, and the tech began to do the ultrasound.  She suddenly told me "You need surgery."  I  was wheeled out very quickly when a new doctor told me something about performing surgery on me and he has to do it now.  I remember telling him, "Doc, I only have one ovary, it's on my right side."  He gave me a weird look.  
I woke up a few hours later, and the doctor came in to check on me.  I found out then that I had a tubal pregnancy which ruptured [My note: that's a pregnancy in the fallopian tube, a potentially terrible problem], and due to the internal bleeding, I could have died.  He also asked me how I knew I only had one ovary and fallopian tube since I had never had surgery, nor have I had anything done that would have told me that I was like that.  I told him I don't know, I just knew.  Very crazy, who knows why I told him, or how I knew. Still freaks me out to this day.

If it was not for that doctor, I would not be here.  People like you are the reason I am alive today.  I don't know who that doctor was, but I am forever grateful I am still alive.  No kids, maybe never, but I have a husband, a dog, and am pretty damn happy now.  And you just can't put a price on a happy life, right?

I just wanted to say thanks for what you do, and saving people like me.

Mrs. L"

I've gotten a lot of letters from people asking me why I chose to go into surgery.  I think this post answers that question pretty definitively.  This is EXACTLY why.  Mrs. L could have died that day, yet here she is over 10 years later - alive, happy, and healthy.  And she's absolutely right - you can't put a price on that.

1 comment:

  1. I wish all doctors knew that it is so important to listen to the patient. I had apendicitis in 2003. As soon as the pain hit me, I knew exactly what it was. At the hospital, they did test after test after test and nothing was conclusive. It took them 7 hours to finally confirm what I had been saying all day. They finally took me back to the OR and, despite being very sore, I felt immensely better when I woke up.


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