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Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

  • 1.  Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 11-30-2020 20:57
    Interesting case from Washington Post's "send us your resolved diagnostic mystery" series... All new to me.

    Sent from my iPhone

    David
    David L Meyers, MD  MBE FACEP
    410-952-8782

    Stomach pain was ruining her life. Then a scan provided a life-changing clue.
    Her unusual diagnosis was followed by a long and rocky quest for effective treatment.

    Read in The Washington Post: https://apple.news/AA-4WGcieS1apaB13IFPq4g

    Shared from Apple News


    Sent from my iPhone

    David
    David L Meyers, MD  MBE FACEP
    410-952-8782


  • 2.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 14:21
    What is so disturbing is this common theme of doctors being downright rude and judgmental of patients when the doctors have been unable to make accurate diagnoses. I wish medical schools would train them in how to respond appropriately. It should be okay to express concern for the patient and admit: “The cause of your symptoms remains elusive but I’m supportive of your continued quest for an accurate diagnosis.”


    Dana B. Thomas, MS, PT
    WakeMed Health & Hospitals
    Raleigh, NC

    Sent from my iPhone


    Original Message


  • 3.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 14:26
    I like Dan Berg's mantra for physicians:
    Prescription for successful patient engagement:
    Lead with curiosity.
    Embrace uncertainty when it exists.
    Reassure honestly.
    Communicate effectively.


    ------------------------------
    Charles Pilcher MD FACEP
    Editor, Medical Malpractice Insights - Learning from Lawsuits
    https://madmimi.com/p/5f4487
    ------------------------------

    Original Message


  • 4.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 18:01
    How do you deal with Chronic complainers?

    When do you stop workups?

    What are the other missed diagnoses for the chronic complainer syndrome?

    Robert Bell, M.D.


    Original Message


  • 5.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 19:40
    Dr. Bell,

    I'm wondering if you can explain a bit more about chronic complainer syndrome.  How do you know a patient has chronic complainer syndrome?  Is it patients with confounding symptoms? Is it patients who have too many symptoms?   Patients who return more than once?  

    I sincerely want to know.

    I think we all recognize the obstacles facing physicians-too little time, poor diagnostic tools, too little reimbursement for the genuine effort it takes to help a patient with complex or rare conditions. 

    Yet no matter how much inconvenience undiagnosed patients represent to the doctor, it is the patient who bears all of the consequences for a lack of diagnosis including all of the physical, financial and emotional burdens. It is their lives that are left in tatters and sometimes lost altogether.

    Still, I do want to hear your point of view.


    Best regards, 


    Sherrill Franklin  
    129 E. Harmony Road
    West Grove, PA 19390






    Original Message


  • 6.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 22:00
    I have to agree with Sherrill. I went back and re-read the article to understand where the "chronic complainer" comment was coming from. I don't see it. I see a patient whose long term but inconsistent problem wasn't caught the first few times. Thankfully, the patient was persistent in seeking care when symptoms were present. Where are the chronic complaints? Actually, where are the complaints? 

    Our job as patients is to present information about our medical history, symptoms, and observations about those symptoms to a healthcare professional. An educated and empowered patient might understand which information is more important than the irrelevant bits but most patients do not. They just tell you what they're experiencing and some of it might be useless. Since when did those become complaints? They're clues to the right diagnostician. And it is the job of the diagnostician to ask the right questions and to stick with a patient until a source for those symptoms is found. 

    So I'm looking forward to an explanation of the "chronic complainer" comment. Perhaps your experience is anchoring your point-of-view in a different direction?

    Best,
    Helene

      
        Website 
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        LinkedIn
     
        Facebook



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  • 7.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-03-2020 09:53
    Thank you Helene for your comments - I am also confused (an dismayed) by the patient blaming term - "Chronic complainer" - and am interested in learning more. 

    In the meantime, I would like to share information about the Society to Improve Diagnosis in Medicine (SIDM). This society is working to understand the causes of diagnostic error. 

    https://www.improvediagnosis.org/what-is-diagnostic-error/


    They list three high level factors that influence diagnostic error: Provider Cognitive Errors, intricacies of the healthcare delivery system, and complexity of the diagnostic process. https://www.improvediagnosis.org/factors-in-diagnostic-error/  

    They have patient stories https://www.improvediagnosis.org/stories/ and webinars and videos on many topics including clinical reasoning https://www.improvediagnosis.org/webinars-and-videos/

    You can subscribe to their newsletter: https://www.improvediagnosis.org/improvedx-newsletter/improvedx-november-2020/patients-gain-control-of-personal-health-information-with-the-21st-century-cures-act-and-opennotes/

    Comments and thoughts are welcomed. 



    ------------------------------
    Marge Benham-Hutchins RN, PhD
    Associate Professor
    Chair, Department of Biobehavioral Health Science
    College of Nursing and Health Sciences
    Texas A&M University Corpus Christi
    ------------------------------

    Original Message


  • 8.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 22:24
    My peers and I were just discussing this recently.  There are some patients who have a compelling story and one gets a gut feeling that something is amiss and yet not identified.  Then there are certain patients where, I admit, I groan when I see them on my clinic schedule. Their symptoms are often vague, inconsistent, described in more catastrophic terms than how the patient actually appears.  The full work up turns up nothing.  Referrals to specialists turn up nothing. They may get angry that you aren't "doing anything for me". Any medication you try is rejected as not working or unpleasant side effects or expensive.   For primary care providers (or I speak for myself), it can be exhausting and frustrating to deal with.  
         The interesting issue is describing the "gut" instinct on has that something is really wrong or not wrong. Type 1 thinking perhaps?


    Denise Bockwoldt



    Original Message


  • 9.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 22:32
    The basic problem for the PCP as a generalist is that many problems are self-limited, and doing a major "work-up" for every complaint is more likely to harm than help the patient.
    Success frequently means using time to clarify things.  Patients should NEVER be "dismissed," or told their problems are in the head.  I found that it is accepted by most to tell them that I do not have a clear-cut answer, that I do not see any evidence of a serious problem and that their symptoms may go away with symptomatic (or no) treatment, but that if they do not, we go to Plan B.
    Ed
    Edward P Hoffer MD, FACP, FACC



    Original Message


  • 10.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-02-2020 00:17
    Thanks Sherrill Franklin. 

    I am not sure that we have the best ways to handle Chronic Complainer patients. 

    It is a problem that needs to be well studied.

    I would welcome hearing that there are good studies that have been undertaken.

    RB




    Original Message


  • 11.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 20:38
    Start at the beginning

    What was the initial chief complaint?

    Trim



    Original Message


  • 12.  RE: Fwd: The Washington Post: Stomach pain was ruining her life. Then a scan provided a life-changing clue.

    Posted 12-01-2020 14:40
    It would be helpful to recall this is written from the patient perspective.
    Thus information that shows someone supportive earlier on is missing.
    This is unfortunate as it tends to lead to simplistic solutions.
    Nuance is needed.

    tom benzoni



    Original Message