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The Doctor Is Too Busy to Save Your Life?

There's something more important to do?

by
Theodore Dalrymple

Bio

September 10, 2013 - 5:30 pm
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Most doctors fall into one of two categories: the smaller, who are excessively concerned with their health and regard each bodily sensation as the harbinger of serious disease, and the larger, who neglect it and ignore their symptoms altogether.

I belong to the latter. When I was a young man, for instance, I failed to recognise the symptoms of pneumonia and ignored them until I could hardly breathe. For me, doctors treated illness; they did not suffer from it themselves.

Even more difficult for many doctors is illness among their close relatives. How far should they interfere with diagnosis and treatment, at the risk of antagonising their colleagues? If they interfere, they might be regarded as difficult and obstructive; if they do not, they may overlook serious and even life-threatening mistakes.

A doctor recounts her experience in a recent edition of the New England Journal of Medicine. Her aged father collapsed at home while she happened to be there; he had recently had a quadruple bypass operation. His blood pressure had fallen dramatically.

At the hospital he was diagnosed with dehydration and given intravenous fluids. For a time his blood pressure improved and he felt better. Then his blood pressure dropped again. His daughter called a nurse who increased the fluids and for some reason switched off the alarm of the blood pressure monitor. Then she left.

When her father’s blood pressure dropped yet again, his doctor daughter went to the nursing station to inform the medical team. There she was more or less cold-shouldered, and because she did not want to appear one of those “difficult” relatives who seem to think that their loved one is the only patient the hospital has to look after, she did not insist. After all, doctors and nurses have many subtle or unconscious (and sometimes not so subtle or unconscious) ways of wreaking revenge on those whom they consider to have caused them unnecessary grief.

The medical team had overlooked one of the most obvious causes of loss of blood pressure in this case, namely internal haemorrhage. The patient was on anticoagulants after his cardiac surgery, and such a complication is not uncommon. His daughter decided to examine him herself by means of a rectal examination and found that he was indeed bleeding intestinally.

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All Comments   (4)
All Comments   (4)
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"The story took me back nearly forty years when I was called to see a man aged 84 who lived alone in an isolated cottage in the country. He had been bleeding rectally for some months and was now so anaemic that he could hardly sit up, let alone walk."

Isn't the good doctor a psychiatrist? An inner city psychiatrist? Interesting.
30 weeks ago
30 weeks ago Link To Comment
I've worked as an ER tech, and it's almost frustrating when a patient who is clearly in need of the medical attention keeps apologizing for disturbing the ER team. I just kept thinking, "You're 65 and you have chest pain!" or "You can't breathe and you need to be here! There are some people here who do not need Emergency medicine, but we actually want to treat you!"
32 weeks ago
32 weeks ago Link To Comment
I had a very similar experience with my mother. She'd had an MI, was in progressive CHF, and had been brought in by the ambulance when she pushed her LifeAlert button; she was in a respiratory crisis. She'd been in a bay for several hours, and they wanted to send her home. I looked at her -- EKG worse than usual, wheezing, and poorly enough oxygenated that I could tell from the color of her fingernails, but they didn't want to admit her because they were short of Kaiser beds.

I had to be quite firm with him.
32 weeks ago
32 weeks ago Link To Comment
We were told in medical school that medical professionalism requires the physician to always place the interest of patients ahead of one's own personal interest, thus nothing we have to do is more important than diagnosing and treating illness and injury, and thus trying to save someone's life. God help us to stay true to our sacred calling in spite of our own personal flaws, or, God forbid, in the face of laws or regulations which may someday stand between physician and patient.
32 weeks ago
32 weeks ago Link To Comment
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