In Happiness in a Storm (p.145), I discuss how physicians sometimes dismiss their patients' complaints. In a recent NYTimes article Denise Grady introduces Dr. Ethan Basch, an oncologist who compared the symptoms reported by patients receiving chemo with the symptoms as they were recorded in their charts by their physicians and nurses. And the gap between what patients report and what physicians record in their charts is real. (See NEJM The Missing Voice of Patients in Drug-Safety Reporting )
Healthy Survivors use this tidbit in healing ways. If you feel your physicians are downgrading or dismissing your concerns, restate your case in a calm, respectful and firm manner. Make sure you understand why your physicians are drawing their conclusions. If the explanations are unsatisfactory, request a second opinion.
As a doctor, I've been fooled both ways: Patients who were sicker than they let on, and patients who sounded like they were seriously ill when they had minor problems. Even if physicians could know that a patient complaining of "excruciating" pain had a problem that can only cause mild pain, this patient has a serious pain problem that needs to be addressed.
You know your body best. And ultimately you are the one who suffers most from a missed diagnosis or undertreated problem. You have a right to second (and third) opinions.
You make an important point that error occur because of very human inability to communicate properly. I would urge you to go further and point out that there are other problems, including excess physician optimism and/or malpratice and/or fear of insurer reprisals for ordering expensive tests. Patients also need to consider the reality that world class rsearch and teaching hospitals can and do deliver care at a level far beyond the care available at even "major medical centers" in large cities.
I say those things from personal experience, having personally observed an experienced oncologist at a major medical center who optimistically decided to order a cheaper CAT scan instead of a PET scan for a smart 51 year old professional womman who was repeatedly in his office telling her oncologist of some 5 years that she believed her indolent lymphoma had returned to active. She reported symptoms including evenng/night cough, bone pain and extreme night sweats. The CAT scan did not reveal the answer, but in fact the NHL had become aggressive. By the time the PET scan was finally run several weeks later, she could barely walk down the block. Two days later, she could not eat and was in excruciating pain (despite 10 mg hydrocodone) because the NHL was by then rampant hroughout her marrow and in her spine. The next day, we fled by plane to a world class hospital in another major city, Upon arrival, the physicians were literally stunned at her condition; I wheeled her onto the NHL clinic floor vomiting intermittently and on fire with pain. With great compassion, attention and skill, the doctors and nurses somehow found a bed for her in the pediatric wing, and brought the pain down over the course of a few days. They then were able to move forward to saving her life with cutting edge treatments far better than she could obtain at home.
In short, patients and their supporters simply cannot be vigilant enought. Malpratice, excess optimism, and fear of insurer reprisals are very real problems, and extreme consequences can follow. And, world class specialty centers really can and do make a difference in the medicine and the outcome.
Posted by: Kirk | April 20, 2010 at 06:49 AM