Archives for June 9, 2006

How docs can be our own worst enemies

I have a relative who had an urgent gallbladder removal recently, and he’s doing well, thanks.

However, we’ve been having some email exchanges about his workup, and specifically a trip to the ED that didn’t diagnose GB dz.  (Patient presented with lower abd pain, N/V; presumably had labs done, though he doesn’t know the results, and had a CT to r/o appy.  No appy by CT).

So, he went home, felt better for a week, then worse again, and went to his PCP.  This is where it’s so easy to look smart by subtly (or non-subtly) saying ‘well, the answer is "x", and they missed the boat by not finding it’. For instance, from an email (excerpt):

…he said I was showing classic symptoms of a bad gall bladder. When he pulled up the results of my CT scan on his computer, he said the results clearly backed that up. He even questioned why the ER doc would not have ordered an ultrasound after seeing the same results. At any rate, he sent me to a surgeon right away. The surgeon agreed with the diagnosis and ordered an ultrasound,…

(emphasis mine).

Now the seed has been planted, and it germinates in law offices with predictable results.  (He’s not going to sue, but now a lot of doubt has been planted in his mind).  It’s the kind of doubt that makes people go from ED to ED for a ‘second opinion’.

I am NOT advocating a code of silence or anything nefarious, but we ALL need to remember that second-guessing and criticism of other docs is neither constructive nor smart.  I have had complaints in the past, generated when the patient followed up with their doctor who (allegedly) tells the patient ‘you should have had ‘x test’, and that ER doc completely missed it by not ordering one’, resulting in a letter complaining about their care, etc.

So, let’s just save our snide critiques for the politicians, okay?