Featured Post of the Month: Unpleasant Encounter, by an Internal Medicine Resident

……. I believe it was the second week of my outpatient medicine rotation. Though not as  exhausting as the routine 12-to-15-hour inpatient medicine shifts, working as a resident in the  outpatient setting also has its challenges. Sometimes laboratory orders and urgent diagnostic  imaging are delayed due to insurance authorizations or perhaps patient’s inability to afford  certain imaging modalities.  

…..The prior encounter 

It was a busy day in the clinic. Patients were instructed to wait longer than usual in order to be  evaluated by a physician. The clinic was overwhelmed and had reached its capacity. I had been  assigned to evaluate a middle age woman with Diabetes who presented to the clinic with right  foot pain and redness of her skin. As I began to review her chart, I discovered that I had actually taken care of her several months ago. During my previous visit, I was overly concerned that she  was in the early stages of developing osteomyelitis (infection of the bone) even though she did  not report of experiencing systemic symptoms such as fevers or chills. I ordered an urgent MRI of her right foot as well as inflammatory markers as this was the next step in evaluating for such  bone pathology. The following day, I received several messages from the clinic staff that the  patient had cancelled her MRI appointment. On hearing this unfortunate news, I reached out to  the patient for further inquiry and she made me aware that her work schedule would not allow  her to make the appointment. I was able to reschedule the MRI appointment at the patient’s  request. To my surprise, the appointment was cancelled for the second time. I reached out to  the patient several times and she was unable to be reached. Several weeks had passed, and the  MRI was eventually performed. The radiologist called urgently to relay the results; “the patient  has early stages of bone infection.” Several calls were made to contact patient but to no avail.  She eventually reached out to the clinic and was prescribed an antibiotic regimen given the  urgency of her diagnosis as untreated bone infection can lead to amputation.  

…Today’s visit might not go well 

As I walked into the room at her follow up appointment, I could sense the tension. I gently  knocked, entered the room and introduced myself as the resident physician in charge of her  care. There was utter silence, much that you could hear a pin drop. Several seconds later, she  began speaking, the pitch of her voice rising several decibels higher, angrily accusing me and  the clinic staff for failing to diagnose and treat her appropriately. At that moment, the feeling of  disappointment and grief began to slowly crawl into the room. Honestly, it was quite an  uncomfortable situation. The entire patient encounter lasted for about 20 minutes, though it  felt like an hour. After this painful encounter, the patient and myself were able to discuss ways  to avoid such unfortunate mishaps in the future. 

-Dr. O. A.

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