By Peter Laird, MD
KevinMD has a wonderful post on a doctor following his instinct and advocating for his patient who was "too young" to have a heart attack, but nevertheless, he was. The forceful actions of the physician in charge of his initial care in assembling a team and advocating for further and complete evaluation saved this young man's life:
Never forget to advocate for your patient
I encountered a young patient recently, just at the cusp of adolescence and adulthood, who had undergone a procedure related to a sports injury. Other people had been responsible for his care during surgery; I was coming on duty for the night and was part of the team watching over him in the recovery room.
Someone came to me and said, “His T-waves are flipped on the monitor. Do you want to do anything?”. . .
. . . Throughout this entire incident my beeper was going off non-stop for other things – OB wanted an epidural, there was an O.R. case to start that I had to postpone, I needed to speak to Joey’s parents who were completely blind-sided by it all. But we ultimately kept our focus on Joey and were able to get him the help he needed. I learned so much from his recovery room course – things I had learned before, but which are always good to learn again.
- Listen to your “gut.”
- Pay attention to the clues.
- Listen to your team.
- Don’t be afraid to call for help.
- and Stick to your guns when advocating for your patient.
I remember one elderly patient who presented to my clinic late in the afternoon. His daughter was an ICU nurse that I knew from the local hospital. He had the acute onset of dizzyness with no other related symptoms. At first, I thought it would be a very common inner ear disorder we see in internal medicine outpatient clinics frequently. However, when I did his examination including a specific trigger of vertigo in the exam room called a Dix-Hallpike test, it was negative leaving the benign condition of vertigo not likely.
I immediately called the local ER and transferred the patient. I gave explicit instructions to the daughter not to let any ER doc discharge her father with the diagnosis of benign positional vertigo. I didn't know what was causing his symptoms at the time, but I had a suspician it was more serious than a simple self limited inner ear disorder. Sure enough, that is exactly what the ER doc did on initial evaluation. But because of my instructions to the daughter, she insisted on further studies. It turns out that her father had a dissecting aortic aneurysm partially blocking the posterior circulation to the brain which caused the acute onset of dizziness. The patient was evaluated by a cardiologist who discovered the cause of his symptoms and immediately intervened. After an extended stay in the ICU, he recovered completely. It was only a return hospital follow up visit that I learned of all that transpired in the ER.
I was trained well for my medical career as a patient advocate, BY MY MOTHER, an RN and also the person solely responsible for saving my oldest brother's life at the age of 12. He developed Hepatitis A after helping my father with flood victims in Fairbanks Alaska in 1967 I believe. However, his condition contined to worsen until he ended up admitted to the local hospital in Nome Alaska. It was a small hospital with only one doctor, a surgeon whose children and I were friends, often snow shoeing in the fields and streams around Nome.
My father came home early one morning and bluntly told my mother, you had better go say good-bye to your son, he doesn't look like he will last long. My mother awoke and said, "like hell I will." It turns out that she had been asking the doctor to consider concommitent diabetes on top of the hepatitis since she had been suspicious of this for some time before he developed the hepatitis. However, these were the days before automated labs and the doctor refused to consider this as a possible cause of his decline. My mother wakened the lab technician at 4am and demanded she perform a simple blood glucose test which showed my brother was in diabetic keto-acidosis as well as hepatitis A.
She awoke the doctor abruptly and asked him if he wanted to give the first dose of insulin or if she would. After an extended recovery in an Anchorage hospital, my brother now owes his last 44 years of his life to my mother's tenacity. I learned my lessons well as a doctor early on, from my mother. It was my pleasure to work side by side her for one year when I was only 19 years old and working as an orderly at a small country hospital in Brookeville, PA where I learned the real art of practicing medicine, always advocate for your patient. Patients trying to survive in this day and age are adrift at sea if they don't have a doctor that is an advocate for them.
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