Saturday, July 28, 2012

Eating Crow

I mentally rolled my eyes. The twenty something sitting in front of me was trying his best to influence my plan, but the clinical decision making was quite straight forward. He had no fever, no shortness of breath, and looked nontoxic. His lungs were clear and he was healthy. It seemed like a no brainer. I tried to explain.


We don't treat bronchitis with antibiotics. Especially someone as healthy as you.

I could tell he wasn't buying my explanation even though he had little choice. I recommended hydration, rest, and to call me in a few days or sooner if his symptoms worsened. Then I shut the door and moved on to my next patient. I hardly though about him after that.

It was with considerable shock that I answered the phone call from the emergency room a few days later. He was septic and hypotensive. His xray showed a dense pneumonia and he needed to be admitted to the ICU. I rushed over to the hospital, and climbed the steps to the second floor with trepidation. By the time I reached his bed, his blood pressure was coming up and the color was returning to his face. He scowled as I walked in the door.

I carefully chose my words expressing regret that he had gotten so sick, without making reference to my decision making process. I was wrong. He didn't get better with rest and fluids. But I had taken the right coarse of action based on current guidelines and knowledge.

Sometimes, that just isn't enough.

As physicians we find ourselves wrong all the time. With the complexity of human physiology and the inadequacy of current medical knowledge, it's a miracle that we bat greater than five hundred. Complicating this fact, is that our profession must answer to a number of impatient mistresses.

The government and health care reform have now erected a monument to parsimony. So sometimes even when you right, your wrong because you utilized too many resources. The critical eye of malpractice lawyers also effects our decision process. Forget parsimony, rightness is defined by leaving no stone unturned no matter how small or remote.

At the end of the day, we have many hands pulling at us.   Even when every patient is home tucked in bed safely,

we still feel like we're eating crow.

2 comments:

tracy said...

Dr. Jordan, i appreciate so much you honesty. You can never be right all the time. All you can do is your best and that is what you do and that is why i admire you so much.

Sincerely,
tracy

Doc Nieder said...

Wow, what a GREAT post. I've been in practice for 20+ years, get lots of kudos from patients and make some really intricate and difficult diagnoses. So why is it the occasional mistake or the patient criticism (warranted or not) that sticks in my craw and will keep me up for days. Why do I think that I can be perfect?