Jim almost convinced me. The burning in his chest, after all, could have just been gastroesophageal reflux. He assured me that the sensation was nothing new; that he got it from time to time after a large meal and took Tums. I couldn’t, however, ignore that it seemed to worsen with activity. The pain was bothersome enough to drag him into my office, without taking the time to make an appointment.
Jim and I argued over the EKG. He wanted to take his prescription and go home. No hospitalization, no blood tests, no diagnostic studies. I grabbed his shoulder, and did my best to convince him to reconsider. He slowly turned back toward the exam room. A few minutes later, I gulped as I looked down at the electrocardiogram. He was having a heart attack. Right there in my office. We called an ambulance and rushed him to the ER.
Jim’s story is nothing new. I can recall countless episodes of personal beliefs contradicting my strongly held suspicions as a clinician. I have begged, pleaded, and occasionally dragged unwilling patients back to the office or into the emergency room.
And occasionally I have saved their lives, or interrupted a malignant disease process before the effects could become irreversible.
Sometimes we are not so lucky. Many clinicians can recall a case in which they had been lulled into a false sense of security by a patient’s own certainty. There is nothing worse than a call from an emergency room, specialist, or coroner notifying you of a deadly misjudgment.
Conversely, every day we face patients who are utterly convinced that they know what is wrong. These beliefs, occasionally correct, but often heretical can be terribly difficult to dispel and lead to over-testing and over-diagnosis.
It’s quite a slippery slope.
So when I read in the newspaper about the latest story of the patient who was certain of the correct diagnosis, yet their pleas fell deaf on their doctor’s ears, I get it.
The layman’s diagnosis is often wrong, but sporadically on target. It takes great courage and concentration to accurately weigh the data, the patient’s beliefs, and science. We actually get it right far more often than not.
We often listen to our patients and take their beliefs into account.
But you mostly don’t read about that in the newspapers.
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of I Am Your Doctor: and This Is My Humble Opinion.
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