Thread by @virenkaul

Saw a patient in clinic today who I’ve not been able to provide answers to on why she’s feeling the symptoms she is feeling. I reviewed her complete history, we went over numerous aspects of her symptoms, how she gets on despite them, her life .. 1/

Performed a complete review of her chart, including a through review of other specialists’ and PCP notes going as far back as possible; together, with her .. 2/

We together looked over all the investigations, tests, imaging done so far and I truly could not come up with a DIAGNOSIS. It felt like a failure. I felt like I was failing her. 3/

At that point I looked at her & admitted that I didn’t have what I felt would be an appropriately satisfying and helpful answer to what was bothering her.

“I am not sure why you are experiencing what you are experiencing, but it’s bothering you and affecting you ...” 4/

“And that’s bothering me, especially that I am not able to help you or even provide good direction” I said to her.

I kept my dejection at not being able to help her, despite all the advances modalities at my disposal, out of my voice. Or I tried. 5/

I offered her two action items:
1/ calling my colleagues taking care of her and having an interdisciplinary discussion.
2/ referring her to another pulmonologist at a center of her choosing for a second opinion. Including working closely with the second opinion doc. 6/

She said: “I am feeling better just knowing you are being honest. I feel like you are treating me like a person. Like a partner in this journey, even though this is only the second time you’ve seen me” 7/

“I don’t think I want another physician. They may know more, but the fact that you have put in this effort to know me means enough to me that somehow my symptoms (anonymized) are already feeling better.” 8/

“Why don’t you speak to the other people on my team and if you all feel that we don’t need to do anything differently, then I feel I am going to be fine!” 9/

“But what about your symptom (anonymized)?”

“Sometimes just being seen and heard can take away the maladies. This maybe one of those times”.

*silence* 10/

“Oh and I’ve kept you too long. If you promise to make those calls and wear another awesome bow tie next time I see you, I bet I’ll be fine.”

I smile. Said bye to her. Called some people. We have a new plan for her. All four of us made it together. 11/

And I amazon shopped for that bow tie. Think she’ll like it. Fin/