……. 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.