Saturday, March 7, 2020


     I saw some one in my office  and she had come to me for second opinion . I did minimal work up and saw the records from the previous consultant  and told the diagnosis . She had come to me as she did ot know what her diagnosis was  and I told her what I thought and then I also told her that we could do treatment or consider open lung bx to confirm my diagnosis.They were impressed  and so I told them that sometimes 3 rd doctor appears to be smart as the first 2 doctors have done the work up and that helps to come to conclusion easily. But what I want to tell today is little different.I am not sure why this happens in medicine . But may be it is due to overconfidence in one self or may be the eyes don't see what the mind does not think or may be we are spending too much time in doing NOTES IN COMPUTER . I just saw a study . The average time spent by a physician in doing a note is 17 minutes per patient - this is not time spent in seeing patient and average duration of  time allotted for follow up is 15 minutes .
    I saw this 78 years old female for shortness of breath. She had high blood pressure  and she had never smoked . She had problem with her aortic valve  and she had surgery to replace it . This one is minimally invasive done with a catheter she had done well. She had seen this cardiologist for many years  and he had told her that she has no cardiac issues. Her primary care physician  did a chest x- ray and also gave her an inhaler which is used  to treat asthma. She felt some minimal improvement  and so he gave her  nebuliser  medications. She had not much change  and so she came to me . I did the work . We did the breathing test and had minimal proof for asthma  and so I gave her different inhaler. My thinking and the work up was pointing to cardiac issues  and not pulmonary problem . But the cardiologist had assured her that there was nothing wrong with her heart..I asked her if her cardiologist has done any tests or just told her that she is fine from cardiac stand point . I never got the answer. I requested the records  and it took long time to get them . I could not find any NEW cardiac tests after she had surgery for the aortic valve. So I ordered a echo cardiogram - ultrasound of the heart and called the cardiologist on his cell phone. I told him that I have ordered a CARDIAC test  and I feel that her problem is cardiac and so may be he can check her out for the same. He agreed.The echo cardiogram was interpreted / read by him  and she had a different valve leaky and also the valve that was repaired was also leaking and the pressure in the lung was elevated due the leaky valve. I called her  and started her on diuretic and told her to call the cardiologist as she needed further work up including heart cauterization. A month passed by and nothing was done  and she got more short of breath and so she went to ER . Now she had fluid collected around her lung and she needed oxygen . I saw her  and started her on diuretics to be given intravenously  and by putting in a needle drained 1100 ml of fluid from around her lungs . She felt great . But the cardiologist that saw her agreed with me  and did cardiac cauterization . AND  he told her tha same findings that were seen 2 months ago on echo cardiogram and told her that she needs new valve . She was sent to a cardiac surgeon .
    So why did the first cardiologist did not diagnose her cardiac condition - I don't know  but I have my theory.   

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