Thursday, November 26, 2015


  I wrote about the change of mind and how most of us do not change the mind . This is true for general public as well as people who consider themselves as open minded and learned . This was obvious to me when I witnessed the Indian election and when I read Musafir. This reminded me of the previous incidence . On an average we don't see physicians in politics , though we do have some now. I had ameeting with a physician who was elected to Florida house. We were about 10 physicians and had a meeting with him . His talk was quite eye opening. Let me explain as to what he said . Usually physicians are taught and act in such a way that there are no two opinion s . If I see a patient with a lung mass on CT scan , I am taught to consider it as a lung cancer and in my mind the possibility of other diagnosis is very low . So I will tell the patient same and work it up same way . I can not consider any OTHER SIDE . On the other side lawyers have different point of view. Say case of divorce or tenant -landlord . Who so ever pays him more money , he will consider that side to be correct and defends it . So for him it is easy to be a politician. So we physicians are nor flexible . We do not change our mind. So I am going to tell a story of not changing our mind .
     I was asked to see this patient on second opinion. This was a 64years old female. who was admitted to ICU. She had a history of high blood pressure and diabetes . She also had history of heart attack. She came out of a supermarket and had chest pain and then became short of breath. She became more short of breath and so the people around called 911. The paramedics came and then they had to put her on a pressurized mask and then they took her to ER. She was quite bad and so she was intubated and put on respirator. She was admitted to ICU . She improved and so the respiratoe was weaned off and she was taken off it . She did ok for few hours . But she got more short of breath in next 6 hours and had to be put back on the respirator. The family was upset and decided they wanted to have second opinion .The physician called me and told me that the lady had Pneumonia and respiratory failure and the family wanted second opinion and I could see patient and then take over . He also told me that she will need Bronchoscopy as we did not know tha cause of the pneumonia . The infection disease consultant was seeing the patient and had started her on 3 antibiotics to treat pneumonia I talked to the patient's husband. She had heart attack and the cardiologist had done cardiac catheterization in recent past and told them that they could not do much about the blockages .I saw the chest X-ray . It looked like to me as congestive heart failure. The X-ray had improved and then gotten worse. Her history of chest pain and sudden onset of shorness of the breath, lack of fever , all pointed to me that she did not have pneumonia , but had congestive heart failure. I ordered blood test for heart attack and congestive heart failure. The BNP , blood test for congestive heart failure was elevated , almost 30 times . She also had may be a heart attach . I also ordered echocardiogram and it showed her heart function to be 20%. So in my mind she had a HEART TATTACK, and had congestive heart failure and DID NOT have PNEUMONIA . she DID NOT NEED BRONCHOSCOPY OR THE 3 ANTIBIOTICS. I explained it to the family and convinced them to continue the same physicians. They agreed . I did see the chart and she had improved . All the cultures were negative and still she had bronchoscopy and the antibiotics were continued and she was still being treated for pneumonia . She did get off the respirator.
    I am still convinced that she did not have pneumonia , but I could not convince the original physician or the consultant , that she had congestive heart failure inspite of all the history and the findings and the blood tests .NO CHANGE IN MIND!!.   

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