Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A missed diagnosis haunts this physician

Anonymous
Conditions
October 10, 2017
296 Shares
Share
Tweet
Share

Eighty percent of diagnoses can be made based on the history and physical.  Take the subjective and objective; throw in some medical history, family history, social history and you can figure out your assessment and plan. Doctors are the detectives of the body and the more facts, the easier it is to solve the mystery.

This is the fictional note that I wrote in my head concerning a fellow physician friend when she approached me in confidence a few weeks ago.

Subjective

Depressed mood, anxiety, insomnia, anhedonia, weight loss present, abdominal pain. Symptoms per patient have been present for one week.  May have been present earlier but seemed to significantly worsen in the past week.

The patient is talking to her friend (me) about how she is feeling.  Walking daily when her friend (again, me) drags her outside. No other exercise.

Managing to go to work and see patients.  Took one day off because of not “feeling herself.”

Suicidal ideations: Not asked (because I honestly didn’t think she was suicidal).

Does not want to do counseling.  Hesitant to do medications and accept that this is depression because of the stigmata in medicine.

Medical history

Two bouts of depression in past that were thought to be strictly situational, treated short-term with medication which was stopped afterward.

Family history

Positive for mental illness of depression and anxiety in first-degree relatives.

Social history

Married, children.  Appears happy with family life. Appears to have social support (including me).

Objective

Weight loss noted.  Mood is quiet, somber. Anxiety present but no delusions or hallucinations. Still showing insight and adequate train of thought.

Basic labs normal.

Assessment and plan

Depression. Convince her that this is depression and recommend medication, counseling and taking some time off from work.  Will check in daily to convince her slowly.  Will continue to be a good friend and offer support.  Will tread slowly so as not to scare her away. Will try to convince her to abandon the stigmata of depression in medicine. Will be honest about my own battle with depression and let her know it is OK for doctors to struggle.

I was wrong. I know she was not my patient, but she was my friend.  We were both doctors, and we had known each other for twenty years. The true diagnosis was major depression with imminent suicide one week after she started expressing her symptoms to me. Hindsight is always 20/20.

Normally with a confusing medical case, you can do an informal morbidity and mortality rounds with your colleagues to discuss the finer points and what could have been done differently.  When your friend commits suicide, it is the opposite.  Out of respect to my friend and her family I keep quiet and do not speak about the details because doctors are in the business of saving lives not taking their own.

I reread the details of my SOAP note over and over in my head trying to fill in the blank spaces.  I stay up at night thinking of words I should have said, questions I should have asked. I read about how female physicians are three to four times more likely than the general population to commit suicide.  Three to four!  That might have been helpful to know a few weeks ago. Four hundred physicians commit suicide annually. And my friend was one of them.

Eighty percent of diagnoses can be made by the history and physical alone, but it is the one that I did not make that will haunt me.

The author is an anonymous physician.

Image credit: Shutterstock.com

Prev

A dean of admissions on affirmative action in medical school

October 9, 2017 Kevin 20
…
Next

After Las Vegas: What is the change that needs to occur?

October 10, 2017 Kevin 49
…

Tagged as: Psychiatry

Post navigation

< Previous Post
A dean of admissions on affirmative action in medical school
Next Post >
After Las Vegas: What is the change that needs to occur?

More by Anonymous

  • Do residents deserve the title of physician?

    Anonymous
  • Breaking down barriers: How technology is improving diabetes management in underserved communities

    Anonymous
  • The patient who became my soulmate

    Anonymous

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Jealousy and missed opportunities in medicine

    Anonymous
  • When physician leaders get acquired and squeezed

    Anonymous
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi

More in Conditions

  • Overcoming Parkinson’s: a journey of laughter and resilience

    Cynthia Poire Mathews, FNP
  • The untold struggles patients face with resident doctors

    Denise Reich
  • Maximize sleep efficiency with stimulus control

    Pedram Navab, DO
  • The endless waves of chronic illness

    Michele Luckenbaugh
  • Surviving and thriving after life’s most difficult moments

    Rebecca Fogg, MBA
  • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

    Alexander Rakowsky, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Four-Year-Old Gets Hospital Bill; Woolly Mammoth Meatball; How AR-15s Damage Humans
  • How This Doctor Found Purpose After a Devastating Injury
  • House Lawmakers Squabble Over HHS Budget
  • Infant Formula Crisis Exposed FDA and Industry Failings, Lawmakers Say
  • Building Vaccine Trust Among the General Public

Meeting Coverage

  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Less Abuse With Extended-Release Oxycodone, Poison Center Data Suggest
  • Novel Strategies Show Winning Potential in Ovarian Cancer
  • Children Do Well With Fewer Opiates After Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • 10 commandments of ethical affiliate marketing for physicians

      Aaron Morgenstein, MD & Amy Bissada, DO | Finance
    • The heart of a Desi doctor: Balancing emotions and resources in oncology

      Dr. Damane Zehra | Physician
    • Safe sex for seniors: Dispelling myths and embracing safe practices [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming Parkinson’s: a journey of laughter and resilience

      Cynthia Poire Mathews, FNP | Conditions
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Maximize sleep efficiency with stimulus control

      Pedram Navab, DO | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A missed diagnosis haunts this physician
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...