The Art of Medicine

My prior TED Talk Blog entry reminded me of a patient I saw in my clinic, many years ago  as a Cardiologist when I was still practicing in a Multi-Specialty Group as well as another "beautiful" TED Talk by Dr Abraham Verhgese ( I published on another Blog I ran during those years) .....

" I recently saw a young woman referred to me for shortness of breath. She had been seen by several physicians and had a recent ER visit for this problem. A week prior she reported some atypical chest pain and a CT scan of the chest was done. She was diagnosed with a "small pneumonia" and given antibiotics. She was told everything else was fine. Her shortness of breath failed to improve, however. She was then referred by her primary care physician to me, because surely there was something wrong with her heart.

 As I walked into the exam room, I noticed she was very pale looking and very anxious appearing. As part of her history she told me that several years ago, she underwent gastric bypass surgery. I asked her if she had blood work done, because my immediate suspicion was that she was anemic. She told me she had it done as recently at the time of her ER visit . My nurse started looking for the labs accessing another database ( even in the community I work, several "Electronic Medical Records" don't "talk" to each other) and not surprisingly, the young woman was profoundly anemic with a hemoglobin of 7.4 ( normal greater then 12), explaining her shortness of breath.

 I don't know what's the saddest part of this story: the fact we don't "look" and "examine" our patients anymore, or being enamored by a CAT scan and completely forgetting to look at a basic blood count or being seen by several physicians, not one of them picking up on the fact that she is a set up for iron deficiency and other micro-nutritional abnormalities because of her gastric bypass surgery and then being referred to a Cardiologist. This is far from being an  isolated case in our current outpatient model of HealthCare. The irony of course is that seeing 30-40 patient a day in clinic is bound to increase the cost rather than curtail it and surely with poorer overall outcomes."