Lessons Learned (An ongoing tale...)

2 things I have learned this week:

1. Pain is a vital sign that one should not ignore
2. ​With all of our access to technology medicine and its practice is truly an art.

The Story...

​Monday while seeing my first patient of the afternoon my lower abdomen felt weird. As any type A doctor does I shrugged it off and continued with the visit. As I was walking out of the exam room with the patient and saying goodbye a severe pain seized me in my lower abdomen and would not let go. Because of where I work had long ago selected one of my colleagues to serve as my PCP. Seeing my pain my wonderful CA (clinical assistant) talked with my PCP’s clinical assistant and got me double booked her schedule. I continued to see patients although much more slowly and with less enthusiasm than I do normally and awaited a break in my schedule. Finally I had one and it was my turn to be a patient. As a doctor it’s weird being on the other side of the computer—trying to accurately describe your symptoms but at the same time not wanting to lead another doctor to any conclusion you may be considering (that is if you have a clue as to what’s going on). It’s even more nerve racking to be on the other side and not have a clue! Which was exactly my position. I had gone through the symptoms formulated a differential diagnosis list but was left with nothing but discards. My exam went as expected and my lab work was negative for infection, electrolytes were stable, and there was no urinary tract infection based on the urinalysis. This left only one next step—imaging of the abdomen and pelvis. I’ll fast forward to the results which were nebulous at best...possible early appendicitis. Therefore nothing definitive. Nothing to hang my hat on. Nothing for my colleague/PCP to hang her hat on. Medicine is as much a science as it is an art and the term practice is hard to put into words. Given her clinical acumen and previous experience she discussed options and I agreed with her a trial of antibiotics; I am in no rush to go under the knife of a surgeon especially since the CT scan read was unsure.


Given my type A nature and work ethic I tried to ignore my pain and I tried to work for a half day and quickly realized that it was a mistake. While clinically I looked fine the pain was very telling. So I have been resting at home taking the antibiotics prescribed and contemplating. I am always acknowledging the role vital signs play in my assessment of my patients but so quick to dismiss them when it comes to personal health needs. I am thankful for those around me who urged me to pay attention. I am also thankful that my physician listened to me and did not dismiss what she could not see or understand. With the advent of technology there is this push to image to see what’s going on inside and while the advent of technology is helpful the lack of noted pathology on imaging does not mean the absence of pathology. As a clinician we must use our knowledge and experience to help guide our plans when technology fails us and as patients we must realize that technology does not always ultimately hold the key, the patients body does.