Missing the Most Important Diagnosis

I almost missed it. I had covered all of the essential medical details of the visit but I nearly overlooked the most important issue for the patient that morning. I caught as he walked out the door.

His appointment that day was for recurrent abdominal pain which was at times severe and debilitating. His problems began a year earlier when he had a case of diverticulitis that resulted in a visit to the emergency room and a week of antibiotics. That pain resolved but in the months that followed he had three more cases of severe pain in the left lower quadrant. He was seen by a doctor on each occasion but, unlike the first episode, diverticulitis was not the cause. All of the tests came back negative and the pains resolved. No one could tell him what was going on.

His most recent episode has been two weeks prior to the current visit to my office. It was bad enough for him to return to the emergency room. Again, no answer was found and the pain resolved. Although the pain had been gone for several days he came to my office to see what the next steps would be. He was full of questions.

“Could it be my gallbladder?” he asked. I explained that it could not be, as gallbladder pain occurred in the right upper quadrant, a completely different area from where his pain was located. His questions continued, and I patiently explained why we knew it was not diverticulitis (normal CT) or an ulcer. While I did a good job of explaining all of the things he didn't have I was not able to give him a definitive diagnosis. I decided to refer him to a specialist for help in determining what additional testing was needed. I completed the referral request online and wrapped up the visit, wishing him well.

As he left the room I walked alongside him, (not out of courtesy,I wanted a cup of coffee and needed to walk the same direction). As we walked I realized what I had missed. I had addressed his questions but I had not addressed his fear.

“It's frustrating not knowing what is going on isn’t it?” I said.

“It is,” he replied.

“It would almost be easier if it was diverticulitis,” I said, “because then we would at least know what we were dealing with.”

“Yeah,” he responded, “I am really worried about it.”

I stopped walking and looked him in the eye. “Don’t let yourself be too worried over this. In my mind there is nothing serious on the list of possibilities. Cancer is not even on my list. We are just being thorough. On a 1 to 10 scale of worry, this is about a 2. Nothing to lose sleep over!” I saw his shoulders relax a visible display of tension releasing.

“Thanks. That really helps.”

As he left I thought about the multiple times in the past that I had not had this conversation, about how many patients had walked out of the room with correct treatment but their major question unanswered. Uneducated in the mechanisms of disease, many patients don’t know which of their symptoms are serious and which are not. When confronted with any change in how they feel, especially a change they have never known about or heard about before, they often think of the worst. Fears of cancer, tumor, serious disease and mortality can often accompany mild illnesses. Doctors, whose medical knowledge allows them to dismiss such fears in an instant, can easily forget that these fears are intense in the minds of their patients. The result is patients who have correct care but still leave the office afraid.

As I reflected on this patient I was reminded of the words of the Apostle John, “Perfect love drives out fear.” As a man of faith, I am called to love the people God brings into my life. If I love, then the fear of others matters. Whenever possible, whenever it is in my power, I need to do my best to address these fears. While John’s words were addressing the truth that the perfect love of God means that His followers need not fear His judgment, I believe the application still applies. I need to reflect the love of God towards others. When I do, people's fears will be addressed and often eliminated.

This truth is not limited to doctors. Incomplete understanding can lead to fear in any circumstance. For me, my lack of expertise in things mechanical can lead me to worry about noises in my car, sounds in my attic, and smells in my garage. I am always grateful when my mechanics, plumbers and handymen are kind enough to explain what is going on and calm my fears.

My prayer for myself is that I will grow increasingly sensitive to the fears of others with each passing day, and that I will take the time to drive it away.

-          Bart

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