I worked in ophthalmology in a large academic center, when an asymptomatic patient came at his wife’s request. The patient had been mowing the grass without eye protection, and felt something enter his eye. He did not think more about it, but mentioned it to his wife in passing.
The patient stressed that he did not want to be there several times during his appointment and stated he was totally asymptomatic. Sometimes male patients can be stoic to the point of total denial. It is our job as medical professionals to sift through the facts and determine the best course of action.
The ophthalmologist performed the exam and a computed tomography scan was recommended. It was the 1980s, so we had to admit patients to expedite an emergency CT. I was performing the history and physical examination, and it became my job to persuade the patient to cooperate with the recommendation.
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I showed the patient slides from a talk I had given on ophthalmic emergencies. One of my slides showed a CT scan of a blade that had broken off in a patient’s limbus. That patient had gone to 11 doctors complaining of “sharp pain in the eye,” but no doctor had ordered a CT scan prior to my attending physician. After much discussion and prodding, the patient finally acquiesced to the procedure and was admitted to the hospital.
My shift was over, so I left for the day. When I returned the next morning, I casually asked my attending if the patient’s CT revealed anything abnormal.
“Wow, did it ever!” he responded.
The patient had a 4 inch wire in his brain and required emergency crainiotomy to remove it. I was amazed he had not reported any pain, pressure or related symptoms.
During the night, there had been a battle of words between the neurosurgeon and the ophthalmologist about who should perform the surgery. My attending physician had to convince the neurosurgeon that he was the appropriate person to remove the wire.
The neurosurgeon stated that the location of the entry wound should determine the medical specialty best suited to perform the procedure. “You mean to tell me that an oral surgeon would be the best person to remove a bullet from the brain, if a patient shot himself in the mouth?” my boss responded.
This ego battle continued for a while before the patient got to the OR, but the neurosurgeon finally removed the wire from the patient’s brain.
The next morning, I visited the patient in the hospital. I asked him if he was surprised by the whole experience and if he ever had a headache during the whole experience.
“Not until they told me I had a 4 inch wire in my brain,” he responded.
We both decided right then and there that wives save lives. This story also is an example of the ego battles between physicians that can impede expedient patient care.
Maria Bips, PA-C, practices in Atlanta, Georgia.
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