December 13th, 2010


CardioExchange welcomes this guest post, reprinted with permission, from Dr. Westby Fisher, an electrophysiologist practicing at NorthShore University HealthSystem in Evanston, Illinois, and a Clinical Associate Professor of Medicine at University of Chicago’s Pritzker School of Medicine. This piece originally appeared on his blog, Dr. Wes.

One more to see after cases were completed. It had been a long day, and I was finding it challenging to summon the effort for one more case. I reviewed the chart. Her past medical history in the electronic medical record read much like a Rorschach blot: 91, uterine cancer, hysterectomy, colostomy, breast cancer, mastectomy, an amputated digit, hypertension, hyperlipidemia, recent stent. The medication list was complicated, but not incomprehensible at least most of the drugs were familiar. I noticed that anti-platelet agents, but not anticoagulants, were part of the mix. “Fall risk,” I thought. I braced myself for another hour’s work, realizing the inevitable. What room was she in again?

The hall was bustling with activity as family members stood outside rooms discussing their loved ones, and nurses skittered from room to room, answering call lights and bed alarms. Patient-transportation personnel were lifting the last patients of the day onto neatly pressed bed linens as they promised a rapid response from the dietary staff.

Her door was closed while most others were open. Why do a procedure on someone so limited? I entered and looked for the quick-wipe alcohol foam dispenser and squirted the foam into my hand, turning to see her. Surprisingly, there was not just one person there, but around the small intervening wall, her husband could be found, too.

This was not the dismal, dreary place I had foreshadowed. Quite the contrary. I had interrupted a fiery proclamation emanating from the tiny frame lying in bed, as she challenged her husband’s desire for her to stay another night. “We’ll discuss this later,” she said, “the doctor’s here now.” She turned to me, smiling, “Yes?”

I introduced myself and explained the purpose of my visit. “Yes, yes,” she said, fully comprehending the circumstances, challenges, potential reasons for her six readmissions in the last three months. She was sharp, engaging, and a remarkably accurate historian not at all what her Rorschach had predicted. She rifled through her own history, explained her symptoms concisely, and looked at me willfully: “Now, how soon can we get going?”

My Rorschach had spoken.

She was simply a delight a firestorm of personality and drive that even the most ardent supporters of the electronic medical record could never have predicted. It was then that I realized its stony information lacked her vision, her wit, her charm. Suddenly, her procedure made sense.

And so we proceeded.

And so did she, right out the door, just as soon as her 93-year-old husband would let her.

3 Responses to “Preconceptions”

  1. Not in EMR but by comments of my “peers” the patient or their parent/parents was/were a disaster. to be as short as possible they ended up being patients of the type you can not forget and that make for that a few that you better don’t talk about.

    Competing interests pertaining specifically to this post, comment, or both:

  2. A delightful story. Left you smiling at the end of your long day instead of just tired.

  3. Karen Politis, MD says:

    I have made a rule to never pass judgement on a patient until I’ve seen him/her in person, having been humbled many a time just like Dr. Fisher.

    Competing interests pertaining specifically to this post, comment, or both:
    No conflicts of interest.