A better way to help patients

May 16, 2008

The author realized his minor, commonplace errors were hampering patient care. See if any of them ring a bell for you.

When we think of our mistakes, we remember the horrible outcomes, close shaves, or malpractice nightmares. But the less obvious errors we make in our daily practices often go undetected, unless they're made with the wrong patient. Here's what my treatment of one particular patient taught me.

Beatrice, an elderly woman, fell off a ladder while cleaning her windows. The fall caused a sudden tearing pain in her lower back. On exam, she had no bruising, and all the signs pointed to a muscular cause of pain. I explained to her that she'd injured her back and should rest and avoid anything that resulted in more discomfort. I gave her pain medication and told her to come back if she wasn't better soon.

"I wish I knew what was causing this pain," she muttered as she hobbled from the office.

"But it's been a week now, Doctor," she protested.

"Sometimes a back sprain can take two weeks or longer to heal."

The next week Beatrice appeared in the office again, this time accompanied by her daughter.

"It's still no better," Beatrice said.

On exam, she seemed to have much more mobility than on her initial visit.

"But it still hurts when I bend over," she said. You said I'd be better in another week, and I'm not. Should I have my back X-rayed?"

I went over the reasoning why that probably wouldn't help.

Another phone call came the next week. Beatrice was still "no better" and she wanted that X-ray. On this busy day, it was simpler to arrange for an X-ray than to argue. I told myself it might yield some useful information. It didn't; the normal spine report arrived two days later. Beatrice had already called several times for the result by then. When I called to tell her the news, I instructed her to see me the following week.

Two weeks later, I hadn't heard from Beatrice so I called to check on her.

"I'm feeling fine," she said, as if I'd asked a really stupid question.

"No more pain?"

"No, my back started to get better just after the X-ray. Why did you wait so long to send me for one?"

"But the X-ray was normal."

"Yes, and as soon as I knew what was causing my pain, I stopped worrying about it and it got better."