I’ve had a two “WTF” moments in my practice of family medicine over the past several months. Still boggles my mind how unconcerned some people are when it comes to their health, or the health of their children.
Case #1 – A woman in her early 60s comes to the office with a complaint of chest pain. It’s not sharp, it’s not dull, it’s “a very heavy, heavy ache, like pressure across my chest.” It has been going on for a few weeks, sometimes once a day, sometimes more. She also had a bit of shortness of breath with exertion but given she had asthma, it wasn’t new to her. I have her do an electrocardiogram at the lab in the building and she returns with the result.
What do we see here?? Come on, I helped you out! Those are ST-segment depressions, a sign of cardiac ischemia. She was given a baby Aspirin in the office and sent to the hospital for immediate assessment. She left AMA (against medical advice) a few hours later. Her white-coat hypertension was at its worst, her blood work was normal and the cardiologist wanted her to stay in hospital until he could arrange an angiogram. Well, the thought of a hospital stay was not one this patient would entertain so she went home. She was pretty adamant that she didn’t want an angiogram, she had heard from friends about “awful” complications and she just wouldn’t entertain the thought. Instead, she wanted to pursue all the non-invasive testing she could to avoid it. She was, quite frankly, in denial that her chest pain had anything to do with her heart. She was convinced it was either her asthma or her heartburn. Almost a month later, the nuclear medicine scan confirmed there was an area of decreased perfusion and angiogram was now the final course of action. Her cardiologist kept telling her there was a 15% error rate in the test, but I couldn’t get the ECG out of my head. Those depressions were real, and they were still present a month later, despite her not having another episode of chest pain.
(As an aside, a few days before her angiogram, news broke of the passing of James Gandolfini, of you guessed it, a massive heart attack. Not a day went by when I didn’t worry that my patient would suffer the same fate.)
The story ends happily. And I feel vindicated. She had the angiogram which confirmed a 90% blockage of a dominant artery in her heart. She had a stent placed and is doing well. Yet, it still completely confounds me how it took over 6 weeks for her to get the intervention done. Had it been me? No way I would have left that hospital. But that’s me.
Case #2 – At the end of a routine appointment, a father asks me if he can bring up something about his 2-year-old daughter (who is also my patient). “It’s probably nothing, but I thought I’d ask since I’m here.” It’s not terribly busy, so I tell him to go ahead. He describes these “episodes” his daughter has where her eyes roll up, her eyebrows start twitching and she is “out of it” for about 15-30 seconds. During this time, she is not responsive to outside stimulus. She comes out of it on her own and returns to whatever it was she was doing. I asked him how long this has been going on for. He says a few months, but maybe longer. Mom is the caregiver, so she’s seen it more. Sometimes it can happen a few times a day. Apparently the girl’s grandfather has epilepsy, so dad was thinking this could be seizure activity.
I saw the child the next day. Mother confirmed what dad had reported. I called up our local pediatrician who saw the child a few hours later. During that visit, she had a seizure witnessed by the pediatrician. The child is now going on to have formal investigations and will see a neurologist in the next few weeks. Apparently, mom just thought she’d “grow out of it”.
I have some patients who bring their child in panicked because a foot hurts for a day or two, and here is a family whose daughter has been having seizures for months and it was only in passing that it was brought up to me. Seriously?!
I just have to shake my head sometimes and think, What.The.Fuck?!