February 6, 2013 in Medical Care
The following story is by Dr. Robert Fenster, a psychiatry resident based at Brown University in Rhode Island , and a winner of the 2012 Costs of Care Essay Contest.
“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”
Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I was a first-year doctor trying to convince her that she was most likely suffering from a migraine and did not need additional tests.
Ms. James had woken up the morning before with very concerning symptoms. Her head hurt terribly. She got out of bed, but she felt nauseated and had to lie back down. She thought she needed her morning coffee, but she felt too sick to go downstairs to make some. Her headache had worsened, and she began to notice shooting pains in her left arm. She was scared. A few hours later, her daughter arrived to find her mother’s speech was slurred. The daughter called an ambulance.
By the time Ms. James reached the Emergency Department, her speech had improved, but her headache remained. The fluorescent lights bothered her, and the loud noises of the hospital grated her nerves. A neurology resident was called to evaluate her. He felt that she was most likely experiencing a migraine and recommended that she be given some medication to help with her pain. He thought it was possible that she could have suffered a TIA—a transient ischemic attack, in which the blood supply to a part of the brain is temporarily blocked—but he felt that this was a less likely possibility. He did not think she would need an MRI scan of her brain unless her slurred speech returned.
The craft of medicine requires doctors to constantly manage probabilities. Read the rest of this entry →