An Easy Diagnosis- Missed

He was worried. He had lost over 30 pounds in the last few months and he did not know why. He had seen another doctor but the doctor did not give him an answer. Worried, he turned to a friend in the medical field. The friend referred him to me.

The visit started off as most new patient visits do, with a lot of paperwork and time spent reviewing his medical history. He had a history of high cholesterol but not much else of significance. He had no symptoms of depression and no obvious reason for the weight loss.

Until I looked at a copy of his blood work.

In December he had a fasting blood sugar of 295, nearly three times the upper limit of normal. He was diabetic. I asked him if he had been informed of the high blood sugar. He told me that the doctor had told him it was “something to keep an eye on” but that no additional tests had been recommended nor treatments suggested.

I explained to him that this was almost certainly the answer to his weight loss, as this was a common manifestation of diabetes. I ordered a repeat of his fasting blood sugar as well as additional tests to confirm the diagnosis. The results were as expected, confirming that he had been diabetic of a while.

At the end of the visit he asked why it was that the other doctor had failed to make the diagnosis. I did not have an answer for him. There was no rational reason that a blood sugar as abnormal as his would be ignored. The only explanations I could think of were ignorance, laziness or incompetence. I kept these reasons to myself, stating only that I did not know what the other doctor had been thinking.

I m not sure that the doctor was thinking at all or that he was truly concerned about the patient. The patient’s diagnosis was simple and straightforward and could have been made by most third year medical students. For several months the patient had needlessly worried about cancer or a life-threatening disease. I wished he had come in sooner and was grateful his friend had advised him to come to my office.

I wish I could say that his story was rare, but it is nowhere near as rare as it should be. Doctors are human and we make mistakes. We can get busy and distracted and we can be lazy and inattentive. Years of advanced training and education bring knowledge but they do not remove our innate tendency to mess things up. There have been many times when I was tempted to cut a corner or to tell myself I would address the problem "the next time." I have thus far been able to fight this tendency. This patient reminded me of why that is important.

- Bart

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