 Robert Filice, M.D. - Dr. Bob's Newsletter |
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Caring: A Missing Ingredient in Medical Care A Case Study of a Case of Acute Painful Arthritis Symptoms I saw a mid-fiftyish year-old woman about 15 months ago for acute painful arthritis symptoms. The rheumatoid arthritis test was off the charts at 500 and the inflammatory marker called CRP was even higher at 75. I also checked for both Lyme’s disease and Mycoplasma infection and she had both of them. The working diagnosis was rheumatoid arthritis until proven otherwise. I wanted to start her on antibiotics immediately for the infectious component, but they do not work immediately and of course the patient wanted some relief. We had some very good and speedy results from a monoclonal antibody treatment called Remicade on some other patients, so I ordered the IV’s to begin. She had a series of these every other week both in this office and then subsequently in the office of a Rush University Medical Center based rheumatologist who agreed with the treatment and the diagnosis. Her symptoms proceeded to improve rather markedly, and her lab markers normalized on this line of treatment! Quite amazing. She was only taking 5 mg of prednisone when her symptoms flared up recently. Because of insurance issues she had to change rheumatologists and saw a new one who was hospital based at Loyola Medical Center. The new doctor reviewed her now normal rheumatoid factor and CRP, prior test results, examined her, and concluded she did not have rheumatoid arthritis. He gave her an ineffective pain medication and took quite some time to order additional lab work. In the meanwhile the patient was hurting and came back to see me. She was confused, and in pain. I called the new doctor to see what his line of thinking was. This is what he told me. First the rheumatoid arthritis test is non-specific and could have been elevated in other diseases. Her latest set of blood tests showed no inflammatory component to her arthritis, and she has no joint swelling evident on exam. Her feet hurt in the wrong place to be rheumatoid arthritis, so maybe she has plantar fasciitis. Otherwise, she probably has Sjogren’s syndrome (an an arthritis-related disease), not rheumatoid arthritis. The Remicade should not have been given so soon, since the “criteria” are 6 weeks of swollen inflammatory arthritis pain before it is started. When the patient was with him, he brought in some students who all nodded agreement that the Remicade should not have been given. It was an important point to him. What about the fact that the patient was now suffering again and could barely walk? When he got the latest test back he’d consider giving her Plaqenil. I wrote this case up for you because it illustrates a very important characteristic of certain (not all) doctors whose domain is the Ivory Tower of academic medicine, the University Medical Center. The main thing to see here is that this doctor was not focused on the well-being of his patient. He was practicing exactly by the “book”, knew everything (at least he thought so), yet he left his patient confused and without relief of the serious presenting complaint of pain. He cared about getting the diagnosis exactly correct, he cared that any medications administered were given only exactly as indicated in the literature, he cared that his students agreed with him and realized how smart he was, and he cared that the patient knew that he was in charge of the case. But the one thing he didn’t care about was the most important thing: he didn’t care about his patient. Yes, theoretically I should have let the patient suffer for 6 weeks before starting the medication, maybe just slapping on some Prednisone to cover things over. Indeed, further testing may prove him right. Maybe she does have Sjogren’s syndrome rather than RA. So what? The patient responded with dramatic symptomatic and lab evidence of remission with the medication I treated her with. He wants to split hairs with me about which inflammatory autoimmune arthritic disease the patient has while the patient is having trouble getting out of bed in the morning? I don’t think so. He also was completely oblivious to the evidence that an underlying infection could and probably was the source of this patient’s illness. Trust me when I say that such an attitude is very common in the doctors hailing from our famous University Medical Centers. But you will also find many such doctors out there in private practice as well. Be prepared for them. They’re the ones that refer to you as that gallbladder, or that lung cancer, or the fibroid case. They appear to be more interested in your lab reports than in you. And you can’t tell them anything, and if you did they wouldn’t listen. They already know everything they want to know. And they don’t really care about you as a person. When you see a doctor like this, don’t give them a second chance. Do what my patient did at my advice. Fire them. And find a doctor that cares about YOU. |
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