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The Patient is the One With the Disease

MedpageToday

"The patient is the one with the disease."

My wife said this to me after I lost a patient from overwhelming sepsis after treating him for a month for acute leukemia.  I felt horrible about that young man's death, perhaps because he was not much older than me and he left behind two young daughters and a lovely wife. 

Somehow, I found comfort in my wife's words because they reminded me that, as a doctor, we sometimes need to remember our role in managing difficult medical circumstances.  We didn't cause their disease.  We have to be reminded that even though we have all of the wonders of modern medicine at our disposal, sometimes people die anyway through no fault of our own.

Unfortunately, our profession has hyped its tools, instruments and outcomes so excessively through magazines, TV advertisements, miraculous TV shows (take "ER" or "House, MD" for instance) and hospital "Top 100" ratings, that the general public has forgotten that we cannot always fix everything or cure everything.  To miss a diagnosis of a relatively rare disease (relative to more common disorders) is no longer acceptable in America. 

Take the instance of actor John Ritter.  It seems his family is because they treated a heart attack instead of aortic dissection.  Never mind that chest pain algorithms are ubiquitous items in all but the finest ER's - you know: get an EKG, give them aspirin and beta blockers if no allergies exist, and don't forget the 90-minute door-to-balloon time!  Go, baby, go!

What, you want to take time to do a CT to rule out dissection?  Are you crazy? To the lab!  Hurry up!  Hell, angiograms can rule out dissection - screw the CT!

No, diagnostic perfection is necessary - even required.  Giving aspirin to an aortic dissection?  Well, that might be contraindicated since it causes bleeding!  You might get sued.  Eeeegads!

Never mind that aortic dissections can involve the ascending aorta and the sinuses of Valsava where the coronary arteries originate.  You mean heart attack can be a manifestation of aortic dissection?

Yes, it can.

But it's not okay to miss an aortic dissection, especially when there stands to be millions of dollars to establish a foundation for people with aortic dissections!  You lowly doctors!  How could you miss such a thing!

Now to be fair, I don't know all the circumstances of this case.  The subtle issues involved obviously will only be resolved in the court of law.  But this lawsuit is an excellent example of why overtesting is performed in ER's every day and why doctors' malpractice rates are excessive. 

Just remember and repeat after me:

The patient's the one with the disease.

The patient's the one with the disease.

The patient's the one with the disease.

Not the doctors.

-Wes