July 28, 2011
I’ve written about it before and I’ll probably write about it again, It’s an emergency until proven otherwise. Chest pain is an emergency until it is resolved and proven to not be of cardiac origin. Abdominal pain is an emergency until it is properly diagnosed and treated. The worst headache you have ever had is an emergency until your brain scan is reported as normal.
Yes, I admit it. I overreact to a lot of things. I am a pessimist by training (http://livewellthy.org/search.aspx?q=pessimist&sc=tcon&dt=a&al=), always guarding against the unseen enemy. I have to be! If I agree with your husband and treat his chest pain as indigestion, I may treat you for depression after the funeral. If I agree with your insistence that your abdominal pain is just the stomach flu, I may have to teach you to change your colostomy bag. If I underestimate your headache and give you the pain pill you are asking for, I may visit you in the nursing home the rest of your life.
Agreeing with you makes you happy the majority of the time. By the same token, disagreeing with you pisses you off when the tests all come back normal and you have to pay for the workup. You get a big, “I told you so!”
It’s an emergency until proven otherwise, and, when the heart attack is real, I’m a brilliant diagnostician, an excellent doc. I saved your life. When it’s indigestion, I’m that quack who over reacts to everything. So who am I? Am I a brilliant diagnostician or a quack?
The answer to that is easy. I am your doc, working hard to keep you safe and well. Like every other doc, I use my experience, knowledge, and evidence to create a differential diagnosis (http://livewellthy.org/2011/04/06/differential-diagnosis.aspx) that is appropriate for your symptoms and then I act to protect and heal you as best I can. I don’t have to be brilliant. I just have to care for and about you. While I may be wrong about what ails you or, in retrospect, misspent your money, I am not a quack.
So the next time I ask you go to the ER, please go! The next time I order an MRI, please get it! The next time I ask you to come to be examined, please don’t argue! I can’t exam you over the phone. There are things that can be done in the ER that I cannot do in the office. An MRI can find things that a physical exam cannot uncover.
One last thing. If it makes you feel good to say, “I told you so”, then say it. If not, then I would be grateful for, “Thanks, doc, for looking out for me.”