Monday, February 4, 2008

A rat's ass

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.


SOCKS said...

You write with such passion, commitment and disgust!
Your patient is lucky his outcome wasn't worse after such a delay in treatment.

Keep it up Dr. Smak - you make a difference.

The MSILF said...

Heh did anyone in the hospital look at his legs?

TBTAM said...

He is so lucky to have you as his doctor.

ljandiernp said...

Did you ask the rad to look at the CT again? Would they read it differently in hindsight? I am always curious when these things happen. I know you had no contrast, but still... He can't have been discharged feeling any better, so it's shameful that no one looked further.


Doctor David said...

Wow! You said it. Sometimes, really all the patient needs is someone who gives a rat's ass. I'm glad, for his sake, that you do.