TIPS FOR SUCCESS
Rock, Paper, Scissors Jacob Adashek, BA
B
ig and burly, strong and stoic, a salt-of-the-earth sort of man, he is both my dad and best friend in one. My rock. Road trips for basketball tournaments, sporting events, and nightly walks while conversing of subjects significant and trivial were our past times. The comfort of knowing he would be there day or night, until he almost was not. Friday night in medical school meant the treat of dining out and then back to the grind of studying. Being a creature of habit, I called my mom and we chatted, but I felt uneasy with a tone I heard in her voice. “Where are you?” I questioned. Silence and a nervous throat clearing before she responded, “the hospital.” Frustration at being kept in the dark welled within me. “What happened? Why didn't you tell me you were at the hospital?” I asked. She quietly explained. “You have enough on your plate, and I know you have a big exam; I was planning on telling you when I knew something.” Being a student, I have limited medical knowledge but wanted to be brought up to speed on what was transpiring. He had sharp, stabbing pain below his left rib cage, chest pain, and soreness above his left shoulder, severe enough to send him to the emergency department (ED). The electrocardiogram came back normal, as did his laboratory test results. The attending physician was leaning toward costochondritis. I asked my mom to request a D-dimer; she was told it would be done with the blood work. It was a relief to hear Dad was cleared for discharge. Instructed if anything changed for the worse to return and told to take ibuprofen for pain. Something was not right. The next day I needed to focus on studying, but checked in frequently with both parents. His pulse and blood pressure were elevated; I had him put an app on his iPhone to check them. However, it was his description of discomfort that did not sit right or seem musculoskeletal. My nagging feeling remained almost 48 hours later. I strongly urged him to go back to the ED. He hemmed and hawed, but my parents heeded my plea and returned. The symptoms were identical, nothing additional. A second electrocardiogram came back fine once again. This evening's attending physician immediately had 3 differentials: pleurisy, pneumonia, or pulmonary embolism. My mom kept me updated in real time. I had questions, among them, if certain tests could be run. The attending physician on this visit was very receptive and offered to talk with me by cell phone. I felt somewhat hesitant to overstep boundaries, but his graciousness relieved me. He perceived my concern and readily discussed my requests. Dad was wheeled away for a computed topographic scan. The possibility of pulmonary embolism made my stomach flip-flop; I hoped for something less threatening. Rather quickly, the results came back: pulmonary emboli in both lungs. Dad was admitted to the hospital, and that was when paper covered rock.
From the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California. Correspondence: Jacob Adashek, BA, Western University of Health Sciences, 309 E Second St, Pomona, CA 91766 (e‐mail:
[email protected]). The author discloses no conflict of interest. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
J Patient Saf • Volume 00, Number 00, Month 2016
The ED doctor and I spoke for the second time that evening, and I asked that Dad be put on a particular medication; he expressed it was his drug of choice as well. Within minutes, we had a problem. The hospitalist was called in since Dad would be admitted. As the well-known child's game goes, rock prevails over scissors, but paper covers rock. The “piece of paper” or degree of the attending hospitalist had trumped my being only a medical student, and he made sure everyone knew it. It was clear this doctor wanted no input from me. This was my dad, my rock, my best friend; and I desperately wanted what was in his best interest. I respectfully requested the same medication approved by the ED doctor, but he was insisting on another. We finally agreed to do it his way (what choice did I have?) until the morning when he assured me a metabolic panel would be repeated. His promise was not kept just as the D-dimer was not run at the first visit. The next day was far better with the discharge doctor who immediately switched Dad to the medication I had asked for from the start. I learned a valuable lesson but not a pleasant one. I was dismissed by chain of command and being right did not matter at all. The helplessness I felt that night was compounded by a physician who seemed more concerned with getting “his way” than with his patient's best interest. Additionally, he would not prescribe a painkiller, telling my parents that the possibility of addiction was real and ibuprofen could be used. My father does not even drink alcohol, and there was no reason to deny him pain relief. When Dad's internist learned of this 2 days later, she shook her head in disbelief and prescribed oxycodone. The hospitalist exemplified what not to do when interacting with a patient, their family, and in general, as a medical provider. This hospitalist's inappropriate demeanor was the smaller of 2 failures by 2 physicians in charge of my father's care. As an aspiring doctor, I was disheartened. The first attending ED doctor had missed the boat, dropped the ball, whatever you name it. His missteps put my dad's life in jeopardy. Sending my father home may have been fatal. Had the D-dimer requested been done, my dad would not have gone through additional days of pain and the very real risk of death from lack of treatment. It can be argued that the second ED physician had the benefit of a second visit to the ED; however, nothing new had presented. It can be debated that the first physician did not order a computed topographic scan because of exposure to radiation and contrast. It then becomes a case of risk versus benefit. It can even be offered that the symptoms were not “text book”. The question swirling in my thought process is how 2 doctors assessing identical patient symptoms took 2 such different approaches. Dad survived; Mom feels grateful. Despite being prematurely discharged from the ED with an incorrect diagnosis, my mom now says, “Well, doctors are human too.” Had the outcome been different, she admits that would not be her sentiment. The medical school I attend stresses the fact that we are lifelong learners. This unfortunate occurrence validates the importance of taking lifelong learning to heart. As medicine evolves and our knowledge expands, some things remain the same. Vigilance, www.journalpatientsafety.com
Copyright © 2016 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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J Patient Saf • Volume 00, Number 00, Month 2016
Adashek
perseverance, a strong work ethic, decency, and devotion are essential. The very same traits my father felt important to instill in his children. One patient of many on a busy night in the ED, but to me, he is my rock, my dad. “To the world you may be one person, but to one person you may be the world.”1
Rock, paper, scissors. Rock, each patient may be someone's rock, their world. Paper, you are entrusted with the degree for the betterment of your patients. Lastly, scissors, to cut to the chase and “when you hear hoof beats, think of horses not zebras.”2 A true trifecta to adopt and remember while continuing my training as a future physician.
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Theodor Geisel Theodore Woodward
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© 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
