A DOCTOR’S LIFE by Weinstein David

Author:Weinstein, David
Language: eng
Format: epub
Publisher: Edgewater Publishing
Published: 2023-03-18T00:00:00+00:00

Returning to the outpatient setting and my patient with the gastric carcinoid tumors, I fell into to the pit of impatience, emotion, and a reliance on first impressions instead of the focused objectivity of science—represented here by the microscope. I told her that I would be surprised if there was no carcinoid present. I was confident that what I had biopsied would prove to be nests of cells with chromatin appearing in a typical “salt and pepper” pattern. I was wrong—I made the same mistake that I had over twenty years ago. So, when the final pathology returned that she was free of disease, confirmed by the pathologist, I called the woman. I apologized and relearned an embarrassing lesson. If it is an assessment based on a patient’s condition, either in the hospital or as an outpatient, make sure all the medical technology and laboratories support your diagnosis and prognosis. Don’t be afraid to ask a colleague to take a second look at imaging or the pathology or recheck all the data yourself. In another case, a patient went to MD Anderson Cancer Center for a second opinion on a case of ovarian cancer. Naturally, MD Anderson insisted that their own pathologist read the slides and not take for granted what our pathologist had concluded. When they went for their final consultation, in addition to the doctor, a social worker was present. The pathologist at MD Anderson read the specimens differently and concluded that the cancer was not simply ovarian cancer with omental implants, a dire diagnosis, but a primary cancer of the uterus as well. Death was certain and sooner rather than later. Together with the social worker the doctor wanted to discuss end-of-life issues. The couple returned to their hotel room in shock. Devastated. Then the phone rang—it was the doctor. He informed them that after they left, he reviewed the case, particularly the pathology report. How could the pathology readings be so disparate? He felt something was amiss, and even though he was at one of the most respected cancer centers in the world, he called his pathologist and asked him to take another look. He then conveyed that the pathologist was mortified. He had misread the slide. It was still ovarian cancer but nothing more. The information was “bad good news” still, but hope was restored. Even physicians in the ivory tower make the same mistakes we serfs tending to the fields do.

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