Sunday, April 26, 2009

The Machines



I saw a middle aged foreign woman the other day who had been in the hospital for several days. Her chief complaint was "right sided abdominal pain". It had started after a meal of chorizo at her home. I reviewed her chart. She'd had a CT scan, an upper endoscopy, a HIDA scan and an ultrasound. The data seemed to be pointing toward gallbladder pathology. When I walked in her room, she was standing, arms akimbo. She didn't look happy. There was a jug of golytely on the night table, presumably preparation for an impending colonoscopy.
-You're the surgeon, she said?
-Yes, Ma'am.
-I called my doctor in Colombia. He told me it is my gallbladder. He said this two days ago.
I pushed on her belly. She was mildly tender in the RUQ. The ultrasound had shown gallstones.
-He may have a point, I said.
-You doctors in America. Too much you do with the machines.

She's right, you know.

7 comments:

platensimycin said...

Perhaps it's because in American court of law, few people would question a test/machine's validity than they would question that of a doctor's H&P. Overtime we get used to ordering a whole battery of tests and "studies" just to validate suspected findings.

Dan said...

It's true. I've always detested the court system (w.r.t. health care lawsuits), but you just made me realize that, as a technologist, my career is riding on it.

I feel so conflicted...

Anonymous said...

Here is a somehow related post from "Notes of an Anesthesioboist" (link).

Granted, it's an extreme case. Moreover, not everyone is alike; nor are surgeons.

Anonymous said...

see, they should have put a second year med student in there, all I know how to do relating to gall bladder path is elicit a murphy's sign. If that actually works in real life...

halfmd said...

Yeah, and how many foreign docs give crazy ass diagnoses such as kidney disease and Dengue fever? I don't trust any diagnosis that comes from south of the border.

Frank Drackman said...

Half MD,
Some of those Mexican Docs are SHARP...I mean the native Mexicans, not the Americans who go there cause they can't get in to schools in the US, those guys usually are stupid as s***. Best Surgeon I ever saw was from Southern Mexico, guy rounds in a Suit, solo practice, doesn't do many elective cases cause he's a Mexican(thats probably changed now) and he takes Trauma call every 3rd so his schedules pretty full with trachs and goin to the ER...Underestimate your adversary at your own peril...

Frank

P.S. those guys from the 3rd world have actually HAD Denge and Schistosoma Cystitis... have you even had Strep Throat??
I haven't.

Anonymous said...

I agree with Frank. While some country's tend to have somewhat lower standards; you still question them at your own peril.