Mij
Senior Member (Voting Rights)
Left Behind by Modern Medicine
Julian Galt, MD
"Modern medicine has produced a vast and growing class of patients with chronic, unexplained symptoms. They are everywhere. I encounter them daily in the ER, and they are easy to find on social media, where whole communities have formed to share grievances and trade theories. These patients are not malingerers. They are genuinely suffering. Yet, the structure of medicine today leaves them stranded, repeatedly told what they do not have while receiving little help in discovering what they do.
Their episodes are uncomfortable but not immediately dangerous. They dutifully see their primary care physician, who, reluctant to miss something catastrophic, refers them to the emergency department. There, a battery of tests is ordered: blood work, imaging, an electrocardiogram. The physician expects these studies to be negative, and they usually are. Occasionally, two or three values stray just beyond the arbitrary limits of “normal.” An albumin slightly elevated. A relative eosinophil count slightly low. These anomalies are clinically meaningless, yet they appear in the patient’s electronic record, flagged with red exclamation marks.
The doctor tells the patient that the results are “reassuring” and may even summarize them as “normal.” What the patient hears is something altogether different. They see flagged results on MyChart, but hear from the doctor that everything is fine. To them, this feels like dismissal or even dishonesty. They believe their symptoms are real and are unsettled by the presence of abnormalities on objective tests. When told there is no emergency, they interpret the message as “nothing is wrong with you.” They leave not reassured but alienated . . .
This cycle repeats. The patient returns to their primary care office, where liability concerns again often dictate referral to the emergency department. Once more, the ER performs its ritual exclusion of life-threatening pathology. Each time, the patient is told that no emergency exists. Each time, the patient hears that their suffering has no cause and deserves no explanation. Their visits multiply. Their frustration grows.
Over time, the patient’s medical record accumulates dozens of encounters. Emergency physicians opening the chart let out a sigh before they enter the room. They see a long trail of “negative workups,” innumerable phone calls, and the note that this individual is a “frequent flyer.” The patient’s symptoms remain unexplained, but now their chart contains a new label: “difficult patient . . ."
Julian Galt, MD
"Modern medicine has produced a vast and growing class of patients with chronic, unexplained symptoms. They are everywhere. I encounter them daily in the ER, and they are easy to find on social media, where whole communities have formed to share grievances and trade theories. These patients are not malingerers. They are genuinely suffering. Yet, the structure of medicine today leaves them stranded, repeatedly told what they do not have while receiving little help in discovering what they do.
Their episodes are uncomfortable but not immediately dangerous. They dutifully see their primary care physician, who, reluctant to miss something catastrophic, refers them to the emergency department. There, a battery of tests is ordered: blood work, imaging, an electrocardiogram. The physician expects these studies to be negative, and they usually are. Occasionally, two or three values stray just beyond the arbitrary limits of “normal.” An albumin slightly elevated. A relative eosinophil count slightly low. These anomalies are clinically meaningless, yet they appear in the patient’s electronic record, flagged with red exclamation marks.
The doctor tells the patient that the results are “reassuring” and may even summarize them as “normal.” What the patient hears is something altogether different. They see flagged results on MyChart, but hear from the doctor that everything is fine. To them, this feels like dismissal or even dishonesty. They believe their symptoms are real and are unsettled by the presence of abnormalities on objective tests. When told there is no emergency, they interpret the message as “nothing is wrong with you.” They leave not reassured but alienated . . .
This cycle repeats. The patient returns to their primary care office, where liability concerns again often dictate referral to the emergency department. Once more, the ER performs its ritual exclusion of life-threatening pathology. Each time, the patient is told that no emergency exists. Each time, the patient hears that their suffering has no cause and deserves no explanation. Their visits multiply. Their frustration grows.
Over time, the patient’s medical record accumulates dozens of encounters. Emergency physicians opening the chart let out a sigh before they enter the room. They see a long trail of “negative workups,” innumerable phone calls, and the note that this individual is a “frequent flyer.” The patient’s symptoms remain unexplained, but now their chart contains a new label: “difficult patient . . ."
