67 year old male. ER visit for shortness of breath, cough.
Chest Xray in the ER negative for pneumonia. Some mild abnormalities seen, followup CT chest recommended. Chest CT without contrast due to renal insufficiency shows some mild abnormalities, but no pneumonia.
All bloodwork, EKG normal.
Patient admitted for 3 days for IV antibiotics for pneumonia. Sent home and followed up with me four days later.
Not feeling any better. Coughing a lot. Short of breath if he walks more than 20 feet. Really short of breath.
Every doctor in the country should now be thinking of this patient's diagnosis. Every 3rd year medical student who passed the first 2 years of school should be thinking of this patient's diagnosis. Hell, if as a layperson you watch enough ER and House you should be thinking of this patient's diagnosis.
I'm not brilliant. I went to a good school, and a good training program, but it wasn't Harvard.
But I give a rat's ass.
And my patient, now on lovenox for his pulmonary embolism, knows it.
This diagnosis wasn't hard. It was all too easy.
Next time you or your family member needs a doctor, look in his or her eyes. You'll know. Sure, we all need a Mayo Clinic specialist from time to time, but most of the time, you just need someone who looks at a patient like someone worth thinking about.