Wednesday, December 08, 2010


One more to see after cases were completed. It had been a long day, and I was finding it challenging to summon the effort for one more case. I reviewed the chart. Her past medical history in the Electronic Medical Record read much like a Rorschach blot: ninety-one, uterine cancer, hysterectomy, colostomy, breast cancer, mastectomy, a digit had been amputated, hypertension, hyperlipidemia, recent stent. The medication list was complicated, but not incomprehensible - at least most of the drugs were familiar. I noticed that anti-platelet agents, but not anticoagulants, were part of the mix. "Fall risk," I thought. I braced myself for another hour's work, realizing the inevitable. What room was she in again?

The hall was bustling with activity as family members stood outside rooms discussing their loved ones, nurses skittered from room to room answering call lights and bed alarms. Patient transportation personnel were lifting the last patients of the day on to their neatly pressed bed linens, as they promised a rapid response from the dietary staff.

Her door was closed while most others were open. Why do a procedure on someone so limited? I entered and looked for the quick-wipe alcohol foam dispenser and squirted the foam in my hand, turning to see her. Startled, there was not one person there, but around the small intervening wall her husband could be found, too.

This was not a dismal, dreary place I had foreshadowed. Quite the contrary. I had interrupted the fiery proclamation emanating from the tiny frame lying in bed as she challenged her husband's desire for her to stay another night. "We'll discuss this later," she said, "the doctor's here now." She turned to me, smiling, "Yes?"

I introduced myself and explained the purpose of my visit. "Yes, yes," she said, fully comprehending the circumstances, challenges, potential reasons for her six readmissions in the last three months. She was sharp, engaging, a remarkably accurate historian - not at all what her Rorschach had predicted. She rifled through her own history, explained her symptoms concisely, and looked at me willingly: "Now, how soon can we get going?"

My Rorschach had spoken.

She was a simply a delight - a firestorm of personality and drive that even the most ardent supporters of the electronic medical record could never have predicted. It was then that I realized its stony information lacked her vision, her wit, her charm. Suddenly, her procedure made sense.

And so we proceeded.

And so did she, right out the door, just as soon as her 93-year-old husband would let her.



Elaine Schattner, M.D. said...

I like this story, that sometimes people will surprise you. It's an example of how doctors can learn from patients. Thanks!

Dennis said...

...every day of quality life is a gift however there is the other life that is not so attractive.

BTW... were you the duty doc at the hospital or were you there for something specific?

Jay said...

Reviewing records allows one to determine what one COULD for a patient.

Only after meeting a patient and performing a face-to-face evaluation does a doctor know what he SHOULD for a patient.

I'm not sure our regulators understand this.

Thanks for a great post.