An unexpected turn

November 19, 2010

As a family physician with more than 20 years of experience in inpatient and outpatient medicine, the author sees part of his role as being an advocate for patients within "the system."

It all started out innocently enough. My wife and I, along with our 2 daughters, were to spend a week at the beach sharing a cottage with my wife's brother and his 3 daughters. My brother-in-law, Kurt, is a single parent and is a computer programmer who works mostly from home. A week in the sun, away from work, sounded great. We even agreed to limit our laptop computers to 1 per family.

Kurt had been working especially hard recently on a big project, spending hours at his computer station at home hunched over his screen. He really needed a break, and I was glad that he wasn't bringing his work to the beach with him.

A TRIP TO THE HOSPITAL

By now, it was about 6 o'clock on a Saturday evening. The small hospital ED was busy, but when Kurt mentioned chest pain to the triage nurses, he was escorted promptly to the back while I decided to stay in the waiting room.

After about an hour, I was summoned to the examination area. The ED doctor-I'll call him Dr. A.-told us that the results of Kurt's electrocardiogram were normal, as were his cardiac enzyme levels. Dr. A. diagnosed pleurisy, suggested that Kurt be discharged, and recommended he take ibuprofen or acetaminophen for pain. At this point, I let Dr. A. know that I was a family physician and that I wondered whether a D-dimer test should be performed to screen for possible thrombosis. Dr. A. initially was a bit put off, but he agreed to order the test. Twenty minutes later, he came by to explain that the D-dimer test results were positive, so now Kurt would need to undergo a computed tomography (CT) angiogram to rule out pulmonary embolus.

Dr. A. was just going off duty, so he literally stopped by on his way out the door. Looking past me at Kurt, he said, "Sorry. I tried to spare you a big workup, but now we have to do the scan." His remarks were a little slap at me and my interference, but I just tried to smile.

Now Kurt was in the hands of Dr. B., the ED physician coming on duty. Dr. B. however, was quite satisfied to stay up in the charting area, away from us, while the CT technician made arrangements for the angiogram. I figured I probably already had established a reputation as a demanding or difficult family member.

At any rate, the CT tech was busy with several other scans, so Kurt's scan was not completed until about 10:30 p.m. At that point, Dr. C., the hospitalist on duty that night, arrived on the scene.