A young, healthy person very close to me called me last night with “a fever and pain on [his] right side.” I had my diagnoses 1 thru 10 (appy!) by that first sentence. He had possibly the most classic story for appendicitis I’ve heard yet in my career. Luckily he was already at the Emergency Department, waiting to be seen by the doctor and was stable and fine, except for all the pain that had migrated over the past hour to McBurney’s point. (I called him this morning, appendix now gone, and he’s already passing gas and doing great.)
But the fact that I was very close to him made the phone call a little uncomfortable to me. Sure, I have plenty of friends that call for medical advice, and almost always it’s “Boy, sounds like a virus, but I’d follow-up with your doctor,” but this time it was different. I knew that by giving him the diagnosis of appendicitis, I was putting him under the knife, and it gave me pause. It made me question myself, in a good way. “Is this really appendicitis? Is there anything else it could be that I’m missing?” This is the good side of subjective medicine–that we should try to perhaps apply this level of questioning and hypothesis to all our patients. Thinking to ourselves, “Gosh, I’d really hate to put my friend under the knife, I really want to be sure I’m right on this one,” and apply this standard to all our patients.
So I did my doubting, asked a few more questions, and felt even more convinced. He then asked me, “Well, should I demand a CT scan?” and again I thought to myself, “Boy, I’d really hate to be wrong on this and risk an unnecessary surgery, maybe he should get a CT scan anyway,” and subsequently realized the flip side of subjective medicine: practicing incorrectly because I care about a person and don’t want to put him at risk. So I thought some more, and turned my friend into any other patient, and realized I wasn’t applying the same standard — and it’s often cases like these, with celebrities, VIPs, relatives — where we apply a different standard, and they often get much worse care than if they were just a regular Joe.
The key is that fine line: treating each patient as if you know them and care about their well-being with the same regard you have for your loved ones, but not doubting yourself so much that your judgment is blurred in the process.
(Yes, duh, I obviously ceded everything to the ER doc and surgeon who evaluated him, saying I would trust their opinion over mine, but I certainly considered the situation as if my friend was in front of me. The story was so classic, the surgeon took him up around midnight, sans CT scan, and took out the big white worm. Also good to recognize that a CT is note harmless, as it exposes patients to radiation.)