We buried my wife’s cousin Ruth last week. She had a strange mole on her arm a couple of years ago. The doctor told her it wasn’t anything to worry about, but he was wrong. By the time she got to the cancer clinic in Chicago, her melanoma had spread to her lungs, and in spite of chemotherapy and radiation, it continued to spread through her spine and, finally, her brain. The somewhat tired looking Ruth we saw at Christmas died last weekend in a nursing home, where, in the end, she had been unable to speak or feed herself. This seems such a horrible and unnecessary tragedy, and Ruth’s family is still in shock. As we sat around her parents’ living room the night after the funeral, some bitter thoughts were voiced about the doctor who misdiagnosed her melanoma. Someone said he should be sued, but Walter and Ellen said they wouldn’t consider it; that would not bring Ruth back. Someone else said he should be stopped from ever practicing medicine again, so he wouldn’t be able to make any more serious mistakes. That’s where I found myself having to defend him. Of course we need ways to monitor the quality of medical care, and to discipline negligent physicians, but “one strike, you’re out” is three times stricter than the controversial laws that impose life sentences on habitual offenders in California and some other states.
To watch over your fellow human beings’ health is a tremendous responsibility, especially on the front lines of Primary Care. Every bellyache is a possible appendicitis, every headache a possible brain tumor, every case of indigestion a fatal heart attack, and every mole a potential melanoma. We have the technology to correctly diagnose these conditions, but can we use all of it in every situation? Does every bellyache require an exposure to the high doses of radiation of a CT scan or the risks involved in an exploratory laparotomy? Does every headache justify an MRI, and does every case of indigestion warrant an admission to the cardiac intensive care unit to rule out a myocardial infarction?
Is it humanly possible to never ever be wrong? And if we punish mistakes by barring doctors from practicing medicine, will there be enough doctors left to treat us? Is it possible to learn and gain experience without ever making a mistake in judgement? I have 63 small “birth marks” on my upper body. They all look harmless, but think of all the spots on all the people out there.
The only way I can think about these questions, without wishing I were already retired, is in the context of a healthy doctor-patient relationship, where the doctor shares knowledge and information with the patient, and every clinical decision is explained in such a way that the patient knows what to expect if all goes well, signs of trouble to be on the lookout for, and when to come back for reevaluation. An authoritarian doctor who gives a categorical answer without explaining his or her diagnosis, and a patient who doesn’t question the doctor’s assessment when things seem to be getting worse are a dangerous combination. We need to communicate better with our patients, and that is where Ruth’s doctor failed her.
After talking about it some more, Ruth’s family agreed that the doctor deserved a chance to learn from his mistake. I hope he does.