When your diagnosis is questioned

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.