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Showing Vulnerability When We Miss the Diagnosis

November 15, 2022

Written by Gabby Leonard

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This op-ed piece highlights the emotional toll missed diagnoses may take on physicians. The author eloquently reflects on how this experience taught her vulnerability and ultimately strengthened her relationship with this patient.

Why does this matter?
Burnout rates of physicians have reached an all-time high, especially during the pandemic era. Current state of the healthcare system encourages rapid triaging and evaluation to decrease length of stay and improve patient satisfaction scores, with the hopes of decreasing hospital boarding. The truth is, with experience comes the chance of missed diagnoses.

“Sometimes, we need to be vulnerable too.”
Dr. Fleming takes us through the journey of a patient who presented to her with a chief complaint of fatigue. She recalls her standard history and evaluation of this patient and comments, “I wonder now if I truly heard his answer or if I was already too far along the path I was following.” This idea of complaint-directed history and physical did not cause her to miss the diagnosis; however, she still carried the burden of a subsequent cardiac event that could have taken this man’s life.

What was billed as fatigue turned out to be coronary artery disease requiring a 4-vessel CABG. Though the patient fully recovered, Dr. Fleming comments on how the patient missed his daughter’s birthday and paints the picture of how this impacted his loved ones. She describes the “crushing weight of my guilt,” which followed her and led to her earnest apology to the patient. She reminds us that, “it is easy to stumble even after years of practice,” and ultimately closes with an insightful reflection. “He reminded me of the power of the relationships we build with our patients. We have the incredible privilege to care for people during some of the most vulnerable moments of their lives, but that means sometimes we need to be vulnerable too.”

Elizabeth A Fleming Notes on Healing After a Missed Diagnosis. JAMA. 2022 Oct 4;328(13):1297-1298. doi: 10.1001/jama.2022.15724.

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