The Patient Is Always Right

“Listen to the patient, he is telling you the diagnosis – Dr. William Osler”

Manjunath Gopal*

Consultant Orthopedic Surgeon, Kauvery Hospital, Electronic City, Bangalore, Karnataka, India

Just before the COVID lockdown, a well-educated and articulate elderly patient was brought to my clinic in a wheelchair.

He started by showing some blood tests. He wanted to know why his alkaline phosphatase was high. He was very concerned about it.

I laid the test results down and asked him to tell me what is the problem. I requested a thorough history and planned an examination.

The detailed history he provided was consistent with dorsal vertebral fracture which was treated with a brace but was not getting better. He had severe tenderness at the same level but without any neurological deficit. Consecutive radiographs showed further collapse from the previous film.

I suggested to him not to google and get worried about blood tests results, and rare complications. However, I went ahead with an MRI scan under sedation (patient was claustrophobic) to rule out pathological causes.

The MRI revealed spinal metastasis. Further investigations showed that the primary was prostate carcinoma.

He was absolutely right in his worry about the blood tests that brought him to the hospital. His concerns were genuine.

My next tasks were to break the bad news, arrange for a urology and neurosurgical reviews, and also refer him to oncology.

I unsuccessfully tried to get in touch with him through the urology team but lost him in follow up. He was being treated in another institution nearby.

Later, his daughter came to our hospital for a different reason, but informed me that he passed away a week earlier.

I felt very sad. I had owed him an apology and felt miserable that I couldn’t offer it in time.

As medical professionals, sometimes we get hassled at patients asking all types of questions based on their internet research on their medical conditions. I think we should gracefully accept this as a part of the practice, and not be condescending in such a situation.