Friday, August 16, 2019


      We are always told to look at the Fine Print . The Dish Network  tell us to look at the Fine Print when we sign contract with cable company and now that the cable companies are in cell phone business, they are telling us to read the Fine Print. So we are always ask to see and read the Fine Print.But one may say what is there in medicine that we need to read Fine Print. When we see patients , many of have tendency to see what is important to our field or specialty. And many  and most physicians have PA or nurse practitioners and they do the notes and the consultants tend to get biased and don't do much on their own . Even the hospital doctors - the hospitalist have the same problem . They do not have their own patients  and the ER doctors or ER pa or nurse practitioners tell them the story and then they admit or their PA or nurse practitioners admit the patients I am not complaining  but just stating the facts . I  still do the same old way. See my own patients  and also read the Fine Print  and sometimes it takes more time but it is more satisfying  and rewarding.This brings me to the today's story.
           I was asked to see a patient who came to hospital for shortness of breath and some chest pain. He was a 51 years old male  and was quite heavy. He was never a smoker  and drank socially only.He had shortness of breath and he felt that started 4 weeks ago only . The ER physician did the work up .He had high blood pressure and he also had other work up done. He was admitted to ICU and hospital doctor saw the patient and then the cardiologist saw the patient . The patients that are admitted are seen by ICU doctors who in many case are lung specialist . So he also saw him . There was no reason to call another lung specialist.But his cousin was a physician and patient called him and he asked them to call me . Si I saw him . He had had clear lungs  and his lungs sounded clear  and his CT scan was OK . He had further cardiac work up and all the work up was negative .
     When I saw him I thought that he may have asthma  and so I started him on inhaler. But when I saw him and looked at the blood tests,I noticed couple of abnormalities. He had elevated proteins  and had one particular type of cells elevated. So I did mention it to them and then and did some additional blood tests .
    I saw him for 3 days more  and then when he was cleared for discharged by cardiologist , he was to be discharged. I had mentioned the need for work up in my notes  and also told the patient  and his wife. No further work up or  any mention of the abnormality or need for work up was done by hospital physician or cardiologist or ICU physician .Finally I ordered hematologist to see patient .
     He was discharged  and saw the hematologist as out patient and he has diagnosis of CLL chronic lymphocytic leukemia.So I read the Fine Print and that helped the diagnosis.

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