Dr. Sanders had another great case in last Sunday’s Times magazine – I did get this one in the paragraph – it actually is easy in retrospect – Sleepless
I especially like this paragraph –
The patient says Helfrich was the only doctor who seemed to truly look at him. During that first encounter, Helfrich didn’t take notes, didn’t focus on his chart, didn’t click through page after page in the computer. He simply asked questions, listened to the answers and observed.
Lisa has a new book coming out this summer – Every Patient Tells a Story. I had the privilege of reading an advance copy. I am recommending this book to all my readers – especially students and residents. She writes beautifully, and makes very important points about the diagnostic process.
{ 3 comments… read them below or add one }
Thanks for spreading word of Sanders’ upcoming book release. I’ve read her Diagnosis column religiously for several years and always enjoy reading her perspective on both common & uncommon diseases. I can hardly wait to read her book!
I liked the lines at the end. I guess the Doctor forgot to consult her lawyer before she spoke.
I’m kicking myself for not diagnosing you,” his primary-care doctor said to the patient regretfully. But the patient continues to have faith in his doctor. “Everybody missed it,” he told me. “But she’s the only one who apologized.
I do apologize to patients. But somethings are mistakes. Some things are unfortunate.
It is not unusual for doctors and relatives to miss the diagnosis of acromegaly since the onset is so insidious. Two adjacent photos may make it obvious and make one feel foolish.
Very often it is a new doctor who quickly recognizes the features for what they are.
I did work in a hospital and on a ward where a surgeon did transphenoidal hypophysectomies at one time.
The important thing to recognize is that medicine is never routine and that one has to keep superior front sheets with problems so that symptoms or diagnoses over time can be seen as they accumulate. The organization of medical information is very important so that syndromes may be more obvious.
One has to stay on one’s toes and look at differential lists all the time since a confluence of symptoms can sometimes lead to an unexpected diagnosis.
Bohdan A. Oryshkevich, MD, MPH