It happens over and over. I call a surgeon about a patient with abdominal pain.
‘Well, what’s the white count?’
‘Normal.’
‘Did you get a CT Scan?’
‘Yes, and it was normal. But they just look uncomfortable.’
‘Sounds like nothing for me to do. Call the hospitalist.’
It happens in other specialties. Cardiologists who aren’t interested in a patient with a normal stress test, pediatricians unimpressed with negative chest x-rays and normal labs. ENT’s unconcerned if the neck CT is clear.
Maybe, just maybe, they’re right! Maybe medicine can be reduced to that place; if the test is negative, the physician is unnecessary. Well, the other physician. The important physician, not the emergency medicine doc. We always have to examine the patient. We, the voice-activated, robotic, perpetual residents for every specialty, actually have to lay our hands on the sick.
I know, I know, medicine is different now. Technology is a great asset. And I can’t expect every physician to come to the ER whenever I call, just to examine someone with ‘normal’ labs, X-rays or CT scans. But what does normal mean?
How many terribly ill patients have I seen with normal white counts? How many sick patients, with ischemic bowel, have had normal CT scans? How many MI patients recently had normal EKG’s and stress tests?
What I’m saying is this; medicine is more than tests! Please, my brothers and sisters, my colleagues of other specialties, don’t surrender all of your education and skill to the test! I try never to call for help; it’s too much trouble. Even family medicine residents balk. ‘What am I going to do?’ Hospitalists hedge; ‘I know they can’t walk, but what can we do in the hospital?’
But please realize, if I call, I really want your help. I probably think there’s a genuine problem. And your help doesn’t consist of informing me what I already know. ‘The test is negative.’ I know that. But the patient is still concerning. Please, act like physicians!
We have made medicine into a series of check-boxes. Enough positive boxes and some other physician might get interested. But humans aren’t like that. Humans fool us; they ignore the boxes. And suddenly, they die without warning.
Do we want to remain a valuable profession? Do we want to continue to treat the sick and be trusted? Do we consider our brains, ears and hands, eyes and even noses to be critical assets in our assessment of the sick?
Or do we just need some scanners and automated phlebotomy machines to evaluate every sick person, and let us know if we’re needed?
I hope not. I like seeing and talking to my patients. Maybe I’m just not bold enough to make every decision by phone, and based on objective data of questionable utility.
I hope I’m never that bold.
Edwin Leap is an emergency physician who blogs at edwinleap.com.
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