I write about medicine, health care economics, and patient education for a living. I closely follow the current news about the high cost of health care and wasted resources. I also write about physicians who are underreimbursed or not reimbursed at all. I sympathize with physicians who are forced by sheer economics to treat patients like so many widgets on an assembly line. But I’d also like to take issue with health care providers who fail to inform their patients about health problems, thereby contributing to both the waste of health care resources and the angst of patients.
A recent health issue of my husband’s is a case in point, and he has the emergency department visits and battery of unnecessary diagnostic tests to prove it. Two years ago, a GI doc gave him the diagnosis of Barrett’s esophagus after an endoscopy showed erosion from stomach acid. The doc prescribed Nexium and a year later, a second endoscopy showed no erosions. The doc said, “Good news. No Barrett’s.” The continued use of Nexium would prevent future problems.
However, soon after being told that the Barrett’s was clear, he went to the emergency department (ED) with chest pains. A cardiologist found a clog in a small artery in the heart. A stent was placed, meds were prescribed, and home he went. But, he continued to have chest pain, a feeling like he couldn’t breathe or swallow right, and tightening in his chest. He returned to the cardiologist who did a second catheterization, exercise and nuclear stress tests, an echocardiogram, chest x-rays, and more. The cardiologist reported that there were no signs of cardiovascular disease, and the stent was open and clear.
For the past year, the problem has continued—chest pain, inability to breathe, a feeling of fullness in his throat, and difficulty breathing. Another trip to the ED, during which he was told his heart and arteries were fine, led my husband to feel foolish and me to suspect that the next doc on the list of specialists should be a shrink. But not wanting to be proven wrong (don’t want to find myself reading a tombstone that states, “I told you so. It WAS the big one”), I urged him to visit the GI doc again.
So he did, convinced that the Barrett’s was back. As it turns out, the GI doc, after hearing the symptoms, said, “Well, that’s your hiatal hernia.” Hmmm. “My what?” my husband said. It turns out that as far back as 2 years ago, the GI doc noted in capital letters in his chart “HIATAL HERNIA.” But not once was that message communicated to us.
During two hospitalizations and after reviewing results of numerous x-rays, nuclear tests, and scans, did no one else notice the hernia? Maybe they did, but didn’t want to bother the patient with the information. And why did the GI doc keep this information a secret for 2 years?
A failure to communicate this simple information and give advice on how to combat the symptoms could have saved several trips to the ED, my husband’s fear that he was having a heart attack, and his conviction that the cardiologist now believes him to be a hypochondriac—a diagnosis I too am fairly certain the cardiologist has made. (Hence, here’s hoping “the big one” doesn’t occur.)
Having knowledge eases a patient’s anxiety, allows the person to take preventive action, and saves use of precious and expensive health care resources.
Freelance Matters 