It was cancer and I missed it. I not only missed it, I missed it badly. The thought of malignancy never entered my mind. He had come in a few months earlier complaining of pain along the lateral aspect of his thigh. He was tender over the iliotibial band so I diagnosed him with iliotibial band syndrome and sent him to a physical therapist. When he came in a few weeks later reporting improvement I was confident I had made the right call.
The improvement did not last and within the month he told me the pain had worsened. Perplexed, I referred him to an orthopedic surgeon. The orthopedist ordered an MRI of the area and the accurate diagnosis was made. He had a tumor in the muscle of his thigh and it was malignant.
I never saw the patient again. Our final contact was over the phone. He had called me to tell me he was firing me as his doctor and would be seeking care elsewhere. He was convinced that it was my fault the diagnosis had been delayed.
I told him I understood his anger and frustration and that I wished I had thought to order the MRI sooner. I explained that he was the first patient with muscle cancer I had ever encountered and that the diagnosis was rare. Because it was rare, muscle cancer was not something high on my list of possible causes. I told him that doctors typically start with common diagnoses and then move down the list, that if doctors began every course of treatment searching for the extremely rare serious condition they would not be good doctors. He was not satisfied with my explanation.
He was not the only patient to leave my practice over his diagnosis. His wife and a family friend joined in the exodus, convinced that I was a “bad” doctor. I grieved at their decision and wondered what I could have done differently.
The truth is there was nothing I could have done. I am a human being with all of the imperfections that come with it. Medicine is to broad and the body too complex for any one doctor to master it all. Perfection is impossible.
In spite of my years of education and hard work, each day I find myself facing the reality that I will miss things. I hate this reality and it is a source of intense fear and anxiety but it is inescapable. I will occasionally make mistakes. Like every working person in the world my only option is to do the best I can every day and hope for the best. When my best is not good enough I have not choice but to accept the outcome and rely on the grace of others. More importantly, I need to extend the same grace to others when they fall short.
-Bart
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