I first heard my mom was sick on Monday afternoon. I had seen her the night before but nothing had been said. I was visiting on break from med school and I am sure she didn’t want to worry me. Five days earlier at a routine eye exam they had checked her blood pressure. It was 223/130, which is pretty severe. She currently takes blood pressure meds and just assumed her dosage needed to be adjusted. Even though she was having severe headaches she figured she could tough it out until she saw her PCP.
As the headaches got worse she went to her doctor, on the same Monday mentioned above. After sitting in the waiting room for a couple hours she was told her doctor could not work her in, and would not be able to do so all week. Realizing she couldn’t wait that long my mother went to an urgent care. They took her blood pressure, decided they could do nothing for it and sent her to an ER. This is the part of the story where I come in.
I got a call from my mother while she was on her way to the ER. I drove to meet her. By the time I arrived she had been carted off to do a CT of her head. The nurse refused to tell me more than that in worry it might be a HIPAA violation; it was an understandable concern.
When my mother returned to her room in the ER I began to ask questions of the nurse, who got very defensive. ”Listen, I am not the doctor and I am not the one ordering tests. Take that up with the doctor.” I hadn’t meant to seem antagonistic, but it seemed I must have been.
When the doctor entered the room he was all smiles and cheer. When I began asking questions he too became agitated. He told me it was a chronic problem he couldn’t fix. I gently reminded him that before last week her pressures had been stable (which could be easily seen in her medical record) and she had not had headaches. He told me that he wouldn’t order tests because he wanted to take a conservative approach. I asked if he thought the head CT was conservative. He said she should go to her PCP. I explained that she had tried that and had been turned away. I also asked if this could be a hormone or kidney problem (such as renal artery stenosis), seeing that she hadn’t been peeing and had gained weight over the past five days. He responded that he could not do that type of work up here. I should probably mention this was a large metropolitan hospital with revenues in the millions and employees in the thousands. The conversation ended with him sending her home with a diuretic.
The next day she got worse. My mother started violently vomiting so I took her an hour in the other direction to another hospital. Even though we did not have insurance with that hospital we knew one of the ER docs and figured he would take us seriously. Upon admission my mother’s systolic blood pressure was still above 200. All it took was a quick physical exam to realize she was hyperreflexic, an early sign of her brain becoming intolerant to the blood pressure. This is what caused the vomiting as well. She was admitted to the hospital so that the internal med group would have time to determine the cause of her secondary hypertension. That is where she remains today.
This event is just one more event on a long list of ways the health care system is failing. Articles like The Bitter Pill have really made me question my ability to help my patients. What is curing a disease worth if you bankrupt the patient in the process? The doctor on Monday would have saved lots of time, pain and money (since we ended up at a hospital outside of our coverage network) if he had simply done a physical exam. This isn’t the only example of negligence or poor doctoring I have encountered this year, and it won’t be the last. These continued occurrences have started to shake my faith in the world of medicine.
I have personally seen doctors be intentionally rude and feign incompetence to a patient because they didn’t want to treat them or see them in clinic. I have seen patients get their diagnosis of cancer while being wheeled out of a room to a next test, giving them no chance to process it. And I have had doctors tell me that when efficacy is the same they will choose to do the more expensive procedure. Don’t get me wrong, I have met great doctors too. But they seem to be few and far between.
How can I practice in an environment like this? How can I feel confidence in my colleagues when I continue to see their mistakes? How can I feel confidence in a system that seems to be helping so few? (And before you say I am just jaded, check out this new report about the U.S. health disadvantage)
These are serious questions I am having; questions that likely have no immediate answer.