Miss Diagnosis

     Our youngest so had so little confidence in doctors even as a boy, that I used to ask him what medical school he graduated from. That's why Tracy recently suffered through four days of severe stomach pain despite my suggestion that he go to urgent care. I let the matter drop, so the fact that he was finally willing to go, indicated the seriousness of the problem. He left with little hope of getting relief and I certainly could not give much encouragement having witnessed so many unsatisfactory medical visits personally, with family members, and with home health patients. In place of platitudes, I urged him to make sure the doctor heard that he could not function in this condition. "Function" is a word health practitioners sometimes respond to.
     So Tracy went to urgent care complaining of severe pain and having been unable to eat or drink for four days. He told the nurse he had taken 800 milligram ibuprofen that did not touch the pain and that it hurt even when he drank water. She suspected gall stones and sent him to the hospital for a CT scan. She correctly diagnosed what was amiss, but her follow up was also a miss. The hospital sent him back to the clinic for further instructions, the clinic sent him home. The nurse practitioner left Tracy a message after hours telling him to take ibuprofen for his pain (hello? we discussed this), not to eat fatty foods (that would be easy since he couldn't eat anything) and to wait for the stones to pass. The latter, to use current vernacular, isn't even a thing. Gall stones do not pass, like kidney stones, although sometimes they get stuck in the bile duct, but that causes even more serious problems. Maybe she was banking on the rare occasions when the stones dissolve, but the odds of that happening are about the same as of winning the lottery.  She also offered to schedule a surgery consultation--eventually.
     The nurse practitioner hit dead on with her diagnosis, but fouled the follow up. What he needed was pain relief, I.V. fluids for dehydration, and surgery. After hearing the nurse's clueless phone message, Tracy and Reed went to the emergency room. I sent Reed along because he knows how to be confrontational enough to be taken seriously, but not taken to jail, as our muscular son might. At the e.r., he (Tracy, not Reed) was given strong pain meds, IV fluids and, since surgery was scheduled for the following day, he was  admitted as an observation patient. I have found the usual length of an e.r. visit to be four to six hours and this was no exception. Reed got home after midnight. But we slept easier, if briefly, knowing our son was finally being taken care of.
     Unfortunately, I have encountered many health practitioners who consider their job done once there is a diagnosis. And the treatment pendulum has swung from getting a prescription every time you see a doctor, to their recommending the over-the-counter products most people try before they go to the trouble and expense of a doctor visit. Four days after Tracy's surgery, the clinic finally called. They wanted to go over his lab results. He wants to go over their heads and file a complaint. I will be glad to help write it. I know how to be confrontational while using pointedly polite language. Medical care that ends at diagnosis misses the point. The patient is not seeking information, he is looking for relief.