Jim almost convinced me. After all, the burning in his chest could have been caused by gastroesophageal reflux. He assured me that the sensation was nothing new; that he got it from time to time after eating a large meal and took an antacid. I couldn’t, however, ignore that it seemed to worsen with activity. The pain was bothersome enough to prompt a visit to my office, without taking the time to schedule an appointment.
Jim and I argued. He wanted a prescription and to go home. No hospitalization, no blood tests, no diagnostic studies. I placed my hand on his shoulder and did my best to convince him to reconsider. A few minutes later, his condition became apparent as I looked down at the electrocardiogram printout. He was having a heart attack. Right there in my office. We called for an ambulance and rushed him to the local hospital emergency department (ED).
Jim’s story isn’t new. I can recall countless episodes of patients’ 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 ED. And occasionally I have saved their lives or interrupted a malignant disease process before the effects could become irreversible.
Sometimes we aren’t 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 in clinical practice than a call from ED staff, a specialist, or a coroner notifying you of a deadly misjudgment.
Conversely, every day we face patients who are utterly convinced that they know what is wrong. Although these beliefs may occasionally be correct, they are often difficult to dispel and lead to overtesting and overdiagnosis.
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 kind of get it.
The layman’s diagnosis is often wrong, but it is sporadically on target. It takes great courage and concentration to accurately weigh the data, the patient’s beliefs, and empiric 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.