We Are Treating People Not Lab Results…Aren’t We?

Ok. Fair warning. I am about to vent. As in seriously go off. Proceed at your own risk.

At least two or three times per week I meet a patient who is new to my office because for years or months she has been complaining of the same thing over and over and feels she really has not gotten any help from her doctor. She has been told that despite her symptoms, all of her tests are normal therefore she is fine.

Don’t get me wrong, as a business owner, I would love to capitalize on this epidemic. However, as a proud physician, I am so disappointed in some of my colleagues that I feel I must object.

Nowhere is this situation more prevalent than in the arena of thyroid disease.

Here is a hypothetical but very plausible scenario:

A woman in her mid 40s has had months of fatigue, weight gain and depression (ok, it could totally be me but realize I am barely in my 40s) . She makes an appointment with her physician, waits patiently for that visit to come around and then lays her heart and soul out to the doctor. He is patient and attentive. He nods at all the right times and places a reassuring hand on her shoulder. He does a thorough exam and…. (here it comes) orders “blood work to rule everything out.” The lovely lady leaves feeling hopeful that now she will finally feel better. Why did she wait so long to call?

A few days later, a chipper nurse calls from the doctor’s office to enthusiastically report that “everything is normal!” “But” whispers the patient, “what now? I still don’t feel good.”

[insert long awkward silence here]

Suddenly that once sympathetic doctor is “too busy” to take the call—if she is lucky. If she is like most, she is informed that there is nothing wrong with her thyroid and perhaps she ought to consider an antidepressant and a weight loss program.

What??

How is it that the same attentive doctor can have such an about face based on a single solitary blood test??? Why is it that the unflagged, unhighlighted number on the laboratory paper suddenly weighs more than the utterances of the living breathing person he has vowed to help?

To keep this from turning into a physiology lesson, suffice it to say that thyroid lab tests are flawed on many levels. We as doctors don’t order complete panels. Labs have arbitrary and wide normal ranges for those panels. And lastly, people are unique. Much like no two people LOOK exactly the same, no two people feel their best at the EXACT same thyroid level.

While this is a very specific and common example, I think the concept has wide implications.

In all aspects of medicine we need to remember that we treat PEOPLE not TEST RESULTS. There was a time when physicians used their clinical skill and instinct to diagnose and treat. Lab values were virtually nonexistent.

And, guess what? People actually had faith in their doctors.

Comments

  1. Anonymous says:

    And that is what makes you a top doctor! When all of the others were telling me that my leg was fine you can to my rescue and helped me figure out what was wrong. It sickens me to think how badly things could have gone if we hadn’t insisted on more testing. -Karen

  2. Christine says:

    Karen–can you message me privately or if you are comfortable, share more of your story? I am racking my brain trying to remember the details but so important!

  3. Anonymous says:

    Oh, the dreaded thyroid! I went through a similar experience as the one you’ve described and thank goodness you decided something wasn’t adding up and you referred me to an ENT. Great timing, I was in the full throes of a thyroid storm! Ellen

  4. Anonymous says:

    I do not mind telling my story… I firmly believe everyone has a story and they almost always help others, so why be shy about it. :)

    In Dec 2007, after training for months and then walking in the 3-day walk for Breast Cancer, my thigh felt very tight and I went to local Dr. X. She told me that I must have pulled a muscle while training/walking and that I just needed some physical therapy. I went to a local PT place in Exton and they worked on my “pulled muscle” for 3 months and discharged me even though I still complained that my leg did not feel any better. They insisted that I just needed to “work it out” and in time my leg would feel better. I continued to stretch my leg for the next few months.

    Summer 2008, I thought I had strep throat and called Dr. X. I was told that I couldn’t get an appointment for a week. WHAT? I immediately started asking my friends who they went to and almost all said they saw this amazing lady in Exton, Dr. Christine Meyer. I called and I was seen that day…. I don’t think I had strep!

    Aug 2008, I went to your office because my leg still wasn’t feeling better and I felt a lump. A CT was ordered, then an MRI, followed by a visit to a surgeon at HUP. A biopsy was done on the lump and it came back inconclusive. I was told that the mass might be cancer, but it also might now be. They weren’t sure. With the help of your office, I was able to get into Memorial Sloan Kettering in NYC within 2 weeks. The pathology team and arrogant surgeon at MSK told me that the mass in my leg was benign and would go away in 3 months. When I asked about what I should do about the pain in the meantime, the surgeon sat up and asked “what pain.” He hadn’t even read the notes that the fellow took in my pre-exam. He then told me that a follow-up MRI would certainly show that the mass has started to shrink which would back up his hospital’s findings.

    The next MRI showed that my mass was still there and had actually grown. After a second inconclusive biopsy at HUP, my slides were sent to a pathology team in Emory. Within 24 hours of receiving my slides, they were able to determine that my mass was actually a high grade, stage 3 sarcoma. YIKES! The surgeon from HUP took 9 days to get in back to me after I found out this diagnosis. In the meantime, I found a sarcoma center and started planning out my cource of attack.

    I went through 3 rounds of chemo (& was supposed to have 6) but my tumors continued to grow so the chemo was discontinued because it wasn’t working. Then I had 25 rounds of IMRT radiation followed up with a radical resection that removed a good bit of one of my quad muscles. 18 months later one of the tumors grew back and I went through 25 rounds of proton beam radiation and another radical resection and femoral artery bypass. It is now almost 18 months since my surgery and I am happy to say that I am CANCER FREE! Yahoo!

    During the last years, you have been by my side helping me understand what’s going inside my body, listening to me talk about my fears of dying and leaving my girls motherless, writing letters to my insurance company when they denied my radiation, pushing to get me into see the best specialist and above all, encouraging me to stay strong. My cancer is rare and at first glance could have been ignored and deemed a lipoma… but you listened to what I had to stay and understood that it wasn’t normal. Statistically, only 4 in every 1 million people get my cancer, if you had gone just by those statistics, I wonder where I’d be today. Once you told me, when I was venting about my medical oncologist, that there is the science of practicing medicine and there is the art of practicing medicine. You need to find the balance between the two. I do believe you’ve mastered this ability.

    Hope this didn’t hijack your blog…

    -Karen

  5. Anonymous says:

    WOW Karen! You are amazing. Thank you for sharing your story. We are all blessed to have Dr Meyer on our side. I am so glad to hear of your fabulous outcome.
    Stay well and all the best for the New Year of 2013!
    Brenda

  6. Christine says:

    Karen-Hijack away my friend! Yours is a story that demands to be told over and over and over again. Brenda–thanks for your kind words and Yes—Karen is AMAZING—really inspiring to anyone that knows her!

  7. Anonymous says:

    This woman in her mid 40′s with weight gain and constant fatigue could be me. All my results came back in the normal range when we reviewed. I changed my diet to ease my mystery stomach pain and it’s helped a little but the weight is still hanging on. This blog reminds me to schedule my follow-up with you!! :)

  8. Anonymous says:

    Doc, my wife is going through some issues right now. She has seen 2 cardiologists. The first did “blood work” immediately. She has since had a heart catheterization and a cat scan of her lungs to loom for clots. The second cardiologist seems to think it may be a thyroid issue and wanted her to cancel the heart cath. Her PCP said the already checked her thyroid and everything was normal. She is also in Her early 40′s. However it is not normal for her to have shortness of breath and chest pain after walking only 5-10 feet. After reading this, I am now wondering if they need to look further. It’s very irritating when they give no answers as to what is wrong. Maybe I need to schedule her an appointment with you. :)

    Earl

  9. Denise says:

    Dr. Meyer, I am that 40 something woman (only a bit younger) and because of this blog post, I switched doctors to your practice. I have my first appointment in two weeks and I am so hopeful that what I have been struggling with for 2 years can be finally uncovered and treated. Thank you!

    • Christine says:

      Denise
      I am honored to have you! Is your appointment with me? Please message/email me details so that I can be sure you are with me. Looking forward to meeting with you!

  10. Mark says:

    THATS WHY SHE’S THE BEST DOC EVER !!!!!!!She does listen.
    OOOOOOOOO btw early 40′s is still 40′s lol
    mark

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