Phew

There are many times when I am tempted to not do my job properly. Too lazy, too busy, can't be bothered, don't really care, wanna go home – are amongst the different excuses. But at one time or another I always get reminded that I should.

I had a patient who got sent to Emergency by her GP because according to her GP, she has acute diverticulitis and requires urgent surgical admission. She even had abnormal blood test results. I thought it was an easy case...just see the patient, call the surgeon and get her admitted. Why would I listen to her chest?

But...she looked breathless and she was speaking in short sentences. I asked her...are you having trouble breathing? She said “Kinda. I have asthma...felt kinda wheezy since this morning”. “Oh, I said “Do you have a cough?” Yep.

Hmm sounds suspicious here. So I took a proper history. She had the abdominal pain and diarrhoea for 3 weeks now- obviously it can't be acute diverticulitis. After a lengthy interview (she was quite a chatterbox and she had lots to complain about!) I asked her what was bothering her the most and she said “Well, the cough, actually”.

I listened to her chest and just as I expected...horrible sounding crackles in her left lung. I was certain it was pneumonia.

I was beginning to doubt the GP. Felt guilty though. Who am I to question a specialist who has trained for at least 5 years longer than me? Surely the GP would've picked up the crackles? Unless she didn't actually listen to the chest at all. It wasn't rocket science. A first year medical student could hear it I'm sure.

I didn't know who to call to admit the patient, really. The surgeon for ?not sure if it's? diverticulitis. Or the physician for pneumonia? The surgeon wanted a CT Abdo before he accepted the patient. Fair enough...if she doesn't have diverticulitis why would he accept her. Unsurprisingly to me, the patient did not have diverticulitis. But what she did have was a rip-roaring pneumonia on chest Xray. Admitted her under the physician with IV antibiotics. With a nasty looking chest Xray and the fact that she is a smoker, the physician thought she might actually have lung cancer by the looks of it.

Now, didn't that make me feel relieved that I did my job properly. That reminds me of a quote from one of our medical textbooks

“More is missed by not looking than by not knowing”

How true that is.