In: Blog, Medical Independant, Rheumatology, The practice of Medicine

Comments Off on The humbling art of medicine — the right to be wrong

I was at a wonderful presentation by a senior colleague recently. Close to retirement, he had been invited to offer some pearls of wisdom to those attending. In doing so he presented a litany of misdiagnoses, delayed diagnoses, mistreatments and treatment failures he had made over the years. We all cringed, squirmed and groaned on his behalf (and our own) but it was an important acknowledgement of how humbling the art of medicine can be, and of the therapeutic benefits of a good confession.

Over my own career, I’ve cocked-up more than a few times. I like to think though, that I’ve learned something from my mistakes. Apologies though, to those patients who I diagnosed as having rheumatoid arthritis who later turned out to have gout (always check the uric acid).

My regrets to the couple of patients I misdiagnosed as having sciatica, who later turned out to have hip osteoarthritis (examine the hips in patients with sciatica — even when your clinic is running an hour behind).

Mea culpa to the GP’s wife whose metatarsal stress fracture I injected with corticosteroid (not everything in the foot that is tender is arthritis), and to the man who’s spinal osteomyelitis I missed (ask about red flag symptoms in all patients with low back pain — especially when your clinic is running an hour behind).

The error from which I learned most happened fairly early in my career as a consultant. I had just set up my practice in Galway, having recently returned from the UK, where I had completed my specialist training. I received a letter from a local GP seeking a second opinion on a patient who had previously been seen and treated by a general physician with ‘an interest’ in my speciality. The treating physician was having difficulty controlling the patient’s symptoms and the patient was getting frustrated.

“Here we go… ” I thought to myself, as I sent for the patient.

Like me, my patient had recently returned from the UK, where she saw a specialist who had made her original diagnosis. After spending a few minutes with her, it became obvious to me that original diagnosis (of rheumatoid arthritis) had been incorrect.

The patient had numerous explanations for her pain other than rheumatoid arthritis and the investigation that was likely to have prompted her original diagnosis (a positive rheumatoid factor test) was due to the fact that she had Sjogren’s syndrome. Because of an incorrect diagnostic label, the poor woman had been taking a whole variety of toxic drugs for years and had spent a fortune seeing the physician privately.

My specialist pride congratulated itself on making such a clever diagnosis and for being smarter than either the physician who had cared for her of late or the rheumatologist who had made the original diagnosis. Gosh, I’m good, I thought.

A conversation ensued.

“That’s wonderful news doctor. You mean I don’t have rheumatoid arthritis after all?”

“Not in my opinion, you don’t.”

“It’s great to see someone who knows what he’s talking about. Do you mind me asking where you did your training?”

“In the UK. In Cambridge mainly.”

“Really, doctor? Were you in Addenbrooke’s then?”

“I trained there for four years.”

“That’s amazing. That’s where I was told I had rheumatoid — by an Irish doctor who was training there.”

With that she thanked me, stood up to leave and just before she left the room, she paused, turned to me and said: “I knew you looked familiar.”

It’s never a bad idea to get a second opinion — even if it’s from yourself.

Originally published in The Medical Independent

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