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her-doctor39s-diagnosis-was-very-wrong

Her Doctor&#39;s Diagnosis Was VERY Wrong

here's a real story about a real patient of mine details obviously change to protect their privacy but it's about a woman's pain that was consistently discounted and blamed on her weight on her gender unfair reasons this case is also Illuminating many of the problems that exist within our Health Care system so I'm going to leave you off with three actionable steps that you can take to improve your health care relationship with your doctor let's get started Becky is a 58 year old female that has a good relationship with the health care System she has a primary doctor she has an urgent care center near her home that she frequents and in general considers herself to be quite healthy over the last few months Becky started experiencing more joint pains and more fatigue so Becky made an appointment to see her primary care doctor in going in for the visit the primary care doctor asked some questions conducted a thorough physical exam and came up with a plan but the plan followed the assessment and the assessment was that Becky being a 58 year old female was in her post-menopausal State meaning that she has went through menopause is experiencing hormonal changes also happens to have a BMI of 29 which puts her into the overweight category therefore the doctor's conclusion was Becky being slightly overweight having this hormonal change due to being post-menopausal is experiencing these joint aches and fatigue due to that not an actual medical condition that can be treated with a specific medication surgery or therapy so the doctor's recommendation was to lose weight to focus on herself to do some reading meditation mindfulness all things that I think most people would see as positive in general so Becky being a good patient went home started this plan tried to motivate herself to lose a few pounds to take some time away from work and go on walks it wasn't until two weeks after that initial visit when Becky woke up and she could barely get out of bed she was experiencing excruciating pain in her shoulders in her biceps in her hips in her low back it was so debilitating that she did not want to get out of bed and even go to work for a person to experience that level of pain and discomfort who was worrying to her in fact Becky's husband urged her to call 9-1-1 and said maybe you're having a stroke but Becky said you know what let's call our doctor and see what's available doctor says they're unavailable for today but recommends that she head on to her local Urgent Care so Becky goes to her local Urgent Care Center they take a thorough history they perform a physical and they don't quite know what's going on so they order a bunch of blood work and Becky is not privy to what blood work was ordered but they told her to take some anti-inflammatories in the meantime until they get the results of that blood work so they gave her a Toradol injection which is a non-steroidal anti-inflammatory medication similar to ibuprofen or naproxen but because it's given intramuscularly it works a little bit quicker patients feel like it's a little bit more of a potent medication so Becky got this injection she felt a little bit better she went home even though she was still in pain she wanted to be a good patient plus she had the little voice in Her Ear of the previous doctor saying this could be related to your weight she didn't lose the weight that she thought she could she didn't follow all the mindfulness practices that she set out to and she started blaming herself which unfortunately a lot of patients do in situations like this three short days later she receives a call from the Urgent Care and they tell her that her blood work has come back and they found that her inflammatory markers were elevated ESR and CRP these are non-specific inflammatory markers so by testing them we don't make a diagnosis of any specific condition for us as doctors if we see that we start feeling a suspicion of an autoimmune condition where their own body attacks itself or perhaps a cancerous process or even an infectious process in some cases she was very worried about this potential diagnosis she did have some family history of cancer and when Becky came in they told her that look there aren't sure exactly what's going on but they believe that given her joint pain was still there that she would benefit from a seven day course of Prednisone which is a steroid that is targeting the inflammation within the body so they gave her seven day course of Prednisone she went home started taking it what do you know the next morning she wakes up feels like a million bucks if she thinks it's solved she feels great day two feels great day three feels great and so on it goes the rest of the week she's very happy and she thinks her problem has been solved but then comes day 10 when she is now three days without the steroid and the pain comes back so Becky trying to be a good patient calls the Urgent Care makes an appointment they see her and they explain that they're not sure what's going on and that they like for her to see a rheumatologist which is a specialist in joint health and autoimmune diseases and they give her a referral Becky again good patient goes home instantly calls tries to make an appointment and given this is March 2023 they give her an appointment for December 2023. nine months so Becky is sitting there in tears wondering why she has to wait nine months while she's in pain not able to perform life duties take care of her home her family go to work and just be even somewhat pain-free so she starts panicking she starts getting really worried and she understands that she has to do something else this is where Becky comes into my office I saw a very concerned patient a patient that was given the runaround no explanation for blood test results I got a sense that she was probably treated unfairly given the fact that she was carrying some extra weight and the fact that she was post-menopausal and I have to make a note here that if a doctor says it would be helpful to for you to lose weight because your joints are experiencing a heavier burden than if you were to lose weight that is good advice in many instances but if there are just jumping to that conclusion without fully examining you fully understanding what's wrong with you doing a thorough evaluation then they may be giving you a misdiagnosis simply due to laziness I needed to make sure and do the due diligence and check where the correct blood tests ordered were they correctly interpreted because honestly when you're going to an urgent care and you're having multiple doctors take a look at you and there's no continuity it's very easy for things to slip between the cracks for things to not get explained or to even get thoroughly logged so I requested all the previous lab work that was done in all of these visits and I found that it was in fact High inflammatory markers the ESR and CRP were elevated something else that was interestingly elevated was something called Ana testing which is anti-nuclear antibody testing that we do to come to a diagnosis of an autoimmune condition but a a testing on its own is not definitive it doesn't help us understand what autoimmune condition is present so I needed to really start from scratch and reorder almost all of the lab work with the exception of things that they've definitely tested and figure out what exactly is going on so I reordered all this lab work I explained to her that she's no longer going to get the run around I'm going to be on top of this I did all the labs and what did I find out it was lupus it wasn't because she was post-menopausal having hormonal changes it wasn't because she was slightly overweight and carrying that burden on her joints these were misdiagnoses and lupus was a missed diagnosis not just her inflammatory markers not just her Ana but other tests that really signify that a patient is experiencing lupus were also elevated like the double-stranded DNA antibody there's actually a scoring system that we use from the American College of Rheumatology that gives scores to certain symptoms that a patient is having plus points for having certain tests flag positive on their results and when I added up her points she fell into the category of definitive positive for Lupus I decided to get her Rheumatology appointment as well she calls gets an appointment for January 2024 these wait times are just astronomical so I called the office and I explained the patient's pain her situation the fact that she's in fear that she's going to be in pain for the rest of her life and we're able to speed up her appointment to just a week and a half two weeks time I called her back I explained everything that was going on why I was ordering certain tests what what the results showed me why I want the rheumatologist the patient was very grateful just that conversation lowered her pain and that's not a placebo effect this is a human survival effect because when we are nervous we are scared we are in a high anxiety state the body turns up its sensory response so by having the conversation calming down her anxiety we're able to help her pain with the conversation alone since then she's had an appointment with the rheumatologist the rheumatologist put her on the correct medication she's doing great couldn't be happier and we're able to help this patient out but what does that mean to you the three takeaways I want to give you from a case like this is all stemming from what you can do to make the encounter better and look doctors need to do better the Health Care System needs to do better but I want to arm you with some very useful skills the first is when a doctor gives you a plan whether it's to take a medication a surgery anything they need to give you at least a working diagnosis they don't give you that you need to ask you need to ask them to document that working diagnosis if they don't know what's going on they should have even a list of potential diagnoses to share with you second ask doctors why they're sending you to a specialist so that a you're not wasting your time B you're not wasting your money and C you can formulate good questions in a plan when you actually go see The Specialist and three this should be common sense but it's an easy question to miss when you're sitting with the doctor and the doctor is telling you here's the plan here's what you do never forget to ask the question what if it doesn't get better how long should I wait if it doesn't get better and what red flag symptoms should I be aware of those questions will save your life and if not saving your life they'll at least make your life a lot easier when you know the plan you know what to look out for you're less anxious you feel less symptoms House MD says it's never lupus in this case it was lupus but click here to watch some really hilarious takedowns of house empty that I did click here check that out as always stay happy and healthy foreign

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