The human side of medicine

December 12, 2018

2018 Physician Writing Contest runner up

I am a solo physician that took over a busy primary care office several years ago. In addition to this undertaking, I am a wife and mother of three young kids. The process of taking over and gaining patient trust has required an overwhelming amount of work and time. Like many other physicians, I have heart-warming stories of success and meaningful moments that have shaped me. 

An experience that stands out occurred with a patient that was only slightly known to me. She was an elderly woman who would come in sporadically-only when she had a concern. She refused to schedule any preventative visits and did not have any significant medical issues that required regular appointments. She came to see me one summer after a slip and fall that occurred at home, because she injured her lower back and wrist. The day I saw her, I performed X-rays of her hand and lumbar spine. While the wrist X-ray did not show anything significant, her lumbar spine X-rays revealed a compression fracture. I ordered an MRI of the spine that confirmed the fracture and referred her to a specialist. 

An ensuing work up occurred for her osteoporosis as well as treatment for her fracture. Along the way, she was lost to follow-up, despite our calls, as she decided to visit one of her children out of state. Several months later, she appeared on my schedule for a follow-up and came in with her daughter. When I entered the room and introduced myself to her daughter, I quickly knew something was amiss. The atmosphere was very cold and they informed me they had come to confront me about a serious error I had made in her care. I was shocked as they started questioning me, inquiring whether I actually read the reports I signed. I assured them I did, as I scrambled to navigate results in her electronic chart. They just sat and watched me as I discovered what they were referencing-one sentence, in the middle of a two-page MRI report, that described an aortic aneurysm; a finding that never made it to the conclusion summary of the report. I was devastated.

Once I absorbed the situation, I acknowledged what had happened and apologized to them sincerely. I proceeded to sit and listen to the events that occurred after the patient traveled out of state. Her back pain had worsened because the aneurysm had expanded, requiring surgical repair. During that time, she was diagnosed with other chronic medical conditions as well. These records never made it to me, despite their requests to forward them, so I was entirely unprepared for what was happening.

Her daughter then proceeded to express the anger she felt toward me, and my patient expressed her deep disappointment as well. Once they finished expressing their concerns and frustrations, I took time to address what occurred. I started, again, by apologizing. I expressed my tremendous relief that her outcome was good. I also explained this was not the result of haste and carelessness, but rather a mistake. I attempted to explain reasons for why I thought this had occurred, but accepted responsibility for my role in this part of her care and the missed diagnosis. Speaking from the heart, I relayed to them that I fully grasped the gravity of potential mistakes I could make on a daily basis; I reminded them that I am only human-while I strive to provide the best care, occasionally I can expect to make a mistake. The experience was humbling and painful, but I am thankful for it nonetheless. 

As physicians, we spend countless hours outside of the hospital/office working and following up on patient care, because we are dedicated to our oath. We all make sacrifices that our patients may never be aware of in order to provide the best care possible. To have that dedication questioned, or to make a mistake despite such great effort, is deflating and discouraging. 

Despite their hard feelings, my patient and her daughter were moved by my apology and granted me forgiveness. They asked me to identify how I could prevent a similar error in the future for other patients as a means of rectifying my error. I committed to follow up on this request, and ensured that I notified them of my findings. I was able to change office processes, as well as my own, to help prevent missing even the smallest finding on a scanned EHR report. I took this opportunity to reflect on my daily responsibilities and to forgive myself for not being perfect. I reaffirmed to myself that I am always committed to doing my best. I was also able to recognize the many variables in patient care that are beyond my control. 

Had the patient never come to talk to me, as difficult as it was to experience, I would have not had the opportunity to learn, evolve, and improve so that I can provide better care for all of my patients. This experience will forever serve as a reminder to me of the human side of medicine and the importance of developing strong patient relationships. Much to my surprise, the patient elected to continue her care with me and is still part of my practice today.

Theresa M. Thomas, DO, is a primary care physician in Clarkston, Mich., and has been practicing for 10 years.
In fourth grade, she won a speech contest detailing her desire to help others, and it has never changed as she pursued a career in medicine to fulfill her dream. “Medicine combines my love of science with my social personality and has resulted in a rewarding career,” says Thomas.

Her favorite part of being a doctor is developing a meaningful relationship with patients, which allows her to provide better and more comprehensive care. But there are challenges, as well. “The most frustrating part of being a physician is dealing with barriers to appropriate patient care from insurance companies and pharmacy benefit managers,” she says. “Many people think our clinical decisions are motivated by personal gain or money, which is far from the truth.”

In fact, her advice to someone graduating from medical school today is to pursue the career because of a love for the job and the patients, not for status or money, because that won’t lead to happiness or fulfillment.
When her career is over, Thomas says she would like to travel and teach residents or medical students. In the meantime, you can find her running races, reading, cooking or watching her kids plays sports when she’s not practicing medicine.

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