Dr. Bernard Lown and the first rule of doctoring

I knock, then enter the exam room. “Hi. My name is John Mandrola.” (Maybe it is my age but I am moving away from calling myself Doctor Mandrola.) “I am a heart rhythm specialist. I have looked at your chart so I know a little about your medical history.” “Can you tell me how you are? What complaints bring you to see me?” What follows is increasingly (and painfully) common: “Doc…I feel good…I have no complaints. The doctors say…” At this point, I reflexly make a questioning face. The patient sees it. He repeats: “No, really, doc, I am okay. I walk three miles a day. I play golf. I do yard work.” “No chest pain?’ “Nope.” “Shortness of breath, dizziness, racing heart?” “Nope.” “You must feel fatigued?” “Nope.” I need to be sure so I ask it another way: “If there were no doctors, no tests, no scans, would you be aware of any problems?” “Nope.” I have been to this place before. Sorry. But the problem–finding disease when there is none–is not getting any better. It takes a doctor right up to the precipice of failure. The danger, of course, is breaking the first rule of doctoring: if a patient tells you he is well, your first job is to not mess it up. Do no harm. Resist the urge. Maybe the ECG machine shows something–the heart is out of rhythm. Maybe a shadow from an ultrasound machin...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs