* * Anonymous Doc

Thursday, February 10, 2011

One right, one wrong.

Saw two patients yesterday at opposite ends of the "what the heck is wrong with them?" spectrum. One guy with a collection of seemingly-unrelated symptoms that seemed to make no sense together-- until it somehow popped into my head that maybe he had a rare syndrome that I think we heard about once in medical school-- and so I sent him for some tests, the results came back, and... amazing, I actually got it.

I don't want to overstate it, but it's moments like that when you remember why you wanted to be a doctor, and where some of the mental challenge comes in. I put the pieces together. The patient didn't come in wearing a sign telling me what he had. I didn't just do the standard workup and pass him along to the next guy. I figured out his illness, and now he'll get the right treatment. Not everyone would have figured it out, he just got lucky that I somehow remembered this thing from medical school. But that's sometimes the difference between good treatment and bad treatment-- you get lucky and get a doctor who knows this particular problem. Not trying to toot my own horn, there are a million issues I know nothing about and someone would be quite unlucky to get me as their doctor. But this time, I was right.

As opposed to the other guy I saw, who seemed to have come directly from a textbook. Every symptom we learn about for a certain condition (I'm trying to be appropriately discreet here), even the tiny ones. Every single one. It was as if he was reading the same checklist we were, and checking every box.

And then I ran the tests, certain of the diagnosis... and... not it.

What is it? Who knows. I don't. He's getting worse. Attending doesn't know either, which sort of makes me feel good, but then when I remember this is actually some patient's health we're dealing with, it's not so good. But at least it's not just me. I guess. I have no idea what this guy has, because every textbook would say he has something else.


  1. Maybe the test came back as a false negative? We had a patient who came with recurrent DVTs who had had two completely negative hypercoagulability workups in the past. We did one again anyway, and sure enough this time she was positive for antiphospholipid antibodies.

    I never knew what to do with this sort of thing. A lot of times tests seem to get treated as though they have perfect sensitivity and specificity, but very few of them do. In any case, I hope you figure it out on this guy. And nice catch on the one you did get!

  2. I see patients like your second one every shift at work. People come in presenting with classic symptoms - concern for heart problems, appendicitis, etc. They get tested and bam - its negative. Then we had a patient who - based on his history - was believed to essentially be making his symptoms up just to get out of his rehab facility - but after a CT turned out to have mets to his bone which caused a fracture. I guess thats why science only takes you so far - then medicine becomes an art form.