Proving a Negative

A young lady comes to the emergency department and wants to be evaluated for a … somewhat nonurgent … problem. Chief complaint: “I’ve lost 50 lbs in the past month.” She felt a little weak as well, but she had just lost too much weight. No other symptoms. The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed abnormal on exam. But she insisted that she weighed 180 pounds just a month earlier. No old records in the computer. I asked her if she could show me a recent picture of herself on her iPhone. She briefly stopped texting to check, but she couldn’t find any. I asked her to show me her drivers license. Nope. Didn’t have that, either. I was quickly developing an opinion that this was a snipe hunt. Snipe hunts like this are an example of another conundrum that many physicians face. We are often expected to prove a negative. Clinically, I can say that the patient did not appear to have lost 50 lbs in the past month. I can even say that it is unlikely [although not impossible - don't comment with all your weight loss feats] that any patient could lose 50 pounds in a month. But what if …? What if the patient had cancer that caused some type of weight loss and I didn’t evaluate her for it? What if the patient had a bad outcome from a metabolic problem that I didn’t screen for? What if, as a result of weight loss,...
Source: WhiteCoat's Call Room - Category: Emergency Medicine Doctors Authors: Tags: Patient Encounters Policy Source Type: blogs