During my internal medicine rotation, I learned many things about medicine, and many things about patient care, and they are not always one in the same. By far the most influential piece of knowledge I will take away from this clerkship is the importance of clear verbal and written patient instructions and education, as well as the benefits of keeping patient care in a network of physicians.
Having worked in many different aspects of health care, I was surprised to discover just how naïve I was regarding long-term patient care in people with chronic illnesses. Thus far in my life, I had always just gone to whatever doctor was most convenient for me, not caring which hospital they were affiliated with, or if they had all of my patient records. There were countless times throughout this rotation that accessing a patient’s previous health records made a huge difference to their care and also the responsible allocation of resources. This was also the case with a patient I helped take care.
This patient came to the hospital for weakness. This chief complaint can obviously be caused by a multitude of different etiologies. When I first started interviewing him, he appeared to be quite able to convey his issues to me. After the history, I began to examine him, and found that quite a bit of information had been left out. The patient conveyed that he had a dermatologic allergic reaction to his blood pressure medication, but he was unsure of the formal diagnosis. This reaction had led to a number of biopsies and a partial penile resection with a permanent supra-pubic catheter, which wasn’t apparent until physical exam (small surprise for me). On further questioning, the catheter had been malfunctioning for more than a week. However, the patient did not seek treatment because he didn’t feel it was necessary. He started to develop increasing weakness until he had to use a cane to walk, and it wasn’t until a scheduled follow-up with a plastic surgeon when they strongly urged him to walk down to the ER to be admitted for sepsis secondary to a complicated UTI.
Afterward I decided to investigate further. Luckily, he was a patient in the Henry Ford system where I was working. I was able to research some more about his condition. It seemed odd to me that an adult male would consent to a resection of one of the most important body parts for a small skin reaction, and especially without understanding the condition itself. As it turns out, the allergy that he spoke of was +ANCA Vasculitis. Luckily the biopsy results were available, again because he had been treated at this same hospital.
During his eight-day stay, the signs of his urosepsis diminished, but his renal function continued to decline. It was discovered (on the medical student’s rather persistent demands for a nephrology consult) that he was now having extensive renal involvement and would need to be on high-dose steroids and cyclophosphamide. The nephrologist failed to communicate this information, and when the infusion nurse came to give him his medication, she told him she would be giving him his chemotherapy for his cancer. The patient was obviously terribly upset that no one told him he had cancer and hadn’t discussed the options with him.
This was an example of how miscommunication between physician and patient can cause dire consequences. This patient did not know what signs and symptoms to watch for if his catheter was malfunctioning, he did not understand what condition he was suffering from, and was further led to believe he had cancer. I spent extensive time discussing his illness with him, and at the end he seemed to have a better understanding about his vasculitis. After his discharge, I called him to see how he was doing. His weakness was improving, and he hadn’t experienced any adverse complications from the cyclophosphamide.
I have always supported the idea of a nationalized health care record for each person. However, now more than ever, it has become abundantly clear how important it is for patient’s past medical records to be accessible to his/her treating physicians.