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Thursday, June 16, 2005

"The best doctors take responsibility for everything they touch"

The quote in the title comes from the following article in Medical Economics. The case history and the physician's narrative and thoughts say a great deal about what it is to be a physician.The events also provide a platform for a valuable lesson on brain hemorrhages from a neurologist who obviously knows a great deal about that.

The general topic is the differential diagnosis of vertigo and some of pearls are you don't necessarily have a headache with cerebellar hemorrhage and the inability to walk is an important finding in the acutely vertiginous patient that might point to the diagnosis of cerebellar vascular insult and a emergency brain imaging study is needed because cerebellar hemorrhage is one of the relatively few times when a neurosurgeon may be needed in a patient with vertigo.

The short version of the story related by an ER doc is that an elderly patient with vertigo was incorrectly diagnosed as having acute labrynthitis.The ER doc relying on the resident's exam and the absence of headache in the history handed off the patient to the next shift and ultimately the patient died with acute cerebellar hemorrhage. A very erudite and useful exposition of the signs and symptoms of cerebral hemorrhage ( and how there need not be headache) can be found here.

Emphasis is placed on the inability to walk as a possible tip off to cerebellar problems and in the setting of an elderly patient with cardiovascular risk factors, cerebellar hemorrhage.The discussion about brain hemorrhage is from the blog NEURO which is a continuing source of great material.
I quote the final paragraph from the article that a ER doctor was brave enough to publish.

"But the best doctors take responsibility for everything they touch. They don't blame textbooks,teachers, or anyone else for their own failings, for relying too much on the absence of one symptom, for not telling Frank [the hand off doc] If she's not walking in an hour, get a CT. The best doctors make everyone around them good enough to save that patient's life."

That kind of attitude is part of what a lay person is transformed into by the best of the medical school and residency training processes. We cannot be transformed into masters of the universe ( a term mentioned in a comment to one of my recent blogs) but I think we can be transformed into caring deeply about what we do and taking responsibility. Or is it the case that those caring about what they do were already that way and all the training gave them a set of skills to be caring in a very special way?

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