Washington Post: Medical Mystery Story #2

The cause of this man’s suffering was hiding in plain sight
A client’s eagle-eyed examination spotted a critical clue that had been overlooked for years.

https://www.washingtonpost.com/heal...63d2aa-1ea6-11ea-8d58-5ac3600967a1_story.html

it mentions (and hyperlinks) chronic fatigue syndrome.

 

"One gastroenterologist even suggested to Lopez that his wife, a nurse, might be poisoning him...but failed to order toxicology tests."

"His primary care doctor at the time, Lopez said, was dismissive, telling him he was “anxious” and “working too hard.” It was an explanation he would hear from other doctors."

"...internist balked, telling him, “You don’t have diabetes insipidus, it’s so rare.” After Lopez insisted, the internist ordered the tests, followed by a second round. All were abnormal, but the doctor remained unconvinced."

“Some arrogant physicians” are offended by an outside doctor’s suggestion, Smith said. “It wounds egos.”


I understand that to become a police officer, thorough psychological exams are carried out to prevent people that are psychologically inappropriate (ie safety risk to public) to graduate as a police officer (leaving aside how effect their process is).

Do medical schools run similar tests on physicians in training to weed out those who are psychologically inappropriate (ie safety risk to public)?

It seems necessary to increase patient safety.

 

Can it really be called the cornerstone of the diagnostic process when it's so rare? It usually happens in hindsight, not to make the diagnosis, unless there is a clearly visible reason to do so anyway. The biggest problem in medicine is identifying that there is a problem at all. There were a few occasions where a partial effort was made in my case but a thorough process? Literally never happened. Most consults were around 5 minutes with few, if any, questions asked. The best way to present a thorough history is to bring notes. Never bring notes to a medical consult unless it has been acknowledged that there is a clear and identifiable process, it's almost an immediate dismissal to psychosomatic.

As for listening carefully to what the patient is saying, I get that it sounds nice to pretend otherwise but in reality patient experience is generally considered so suspect as to be misleading, and is mostly dismissed, by most physicians. It almost never happens this way and this is a major part of the problem, especially with us. It sure is how things should work but it is not how they do.

The entire MUS paradigm is a complete rejection of this approach, one that guarantees failures like this one. It specifically advises not to test anything beyond the basic, reject what the patient is saying and quickly redirect to a psychological default, which likely would have resulted in this man's suicide a few years down the line, probably with no connection back to an acknowledged medical reason.

Perception of how medicine actually works seems to be painted very rosy by medical drama on television. It's simply not how it works, the further a case is from having clear signs and symptoms, the worse it gets and fast. The gap in quality of care between acute and visible and chronic and invisible is basically the whole damn universe, with almost inverse effort and outcomes. As incredibly good as medicine has gotten in dealing with acute problems, it's about just as bad in dealing with chronic ones. It doesn't help to continue denying this reality and just how much of that failure is a direct result of choices.