Smarter Than Me

Here is a cool story that came out in the Washington Post. A young woman was diagnosed with an ependymoma by a family doctor at the student health center. She had gone in with symptoms of morning nausea and vomiting that went away as the day progressed. She had seen her regular doctor a few times and then even saw a gastroenterologist. The specialist did an endoscopy and found no cause for her symptoms. As the story goes, the patient saw a different family doctor who was filling in and he "magically" knew what was going on. Within minutes he diagnosed her and got her admitted to the hospital where it was found she had a brain tumor.

There is something that didn't sit right with me as I read this. Don't get me wrong, as a family doctor I do like to hear stories where my brethren is a hero but the article states that the patient saw this new doctor and within "minutes after examining her" knew what was going on. Later, the doc says,"one of the things they teach you in medical school is that if you just take the time to listen to patients, they'll tell you what's going on." Maybe. I am not so sure he actually took all the time in the world (minutes?) or something intuitively clicked that clued him in. If you ever read the book Blink then you know what I mean. We are also taught in medical school that when you hear hoof beats then you should think horses, not zebras. In other words, common things are common and not every case of nausea should lead us to order an MRI of the brain.

Another issue with this piece is that is makes the other doctors seem incompetent, rushed and non-caring. I am not so sure they were. The patient was initially seem in November of 1999. By the time she saw the family doctor at the end, she had been through medical management, specialist referral, and endoscopy. That was all done by April 2000 which was five months total. That really isn't too bad. New symptoms had arisen as well which was not available to the first doctor. She had lost 10 pounds, was having visual trouble, and was so weak and frail that she couldn't even do the laundry. This gives the "new" doctor an advantage and probably helped him in his diagnosis.

My point is that the way this story is told makes some very qualified professionals look bad. I love that the family doctor is put on a pedestal here but we all can't be House. That is for television which is where this story will eventually end up. I, too, would have missed this diagnosis at first. I don't always have the luxury of time but it wouldn't have mattered as her initial symptoms were common and nebulous. Hopefully with good follow-up I would have picked up on this zebra as well. That is the real advantage and benefit of seeing your primary care doctor. That's what makes us so important to our healthcare system.