I am a gastroenterologist who has been practicing for decades. One would think that with my diagnostic cunning and length of service that I would be able to identify the cause of your stomach distress from across the room. Alas, abdominal distress is often more cunning than the medical sleuths who aim to unmask its identity. A reality of gastroenterology is that abdominal pain – an issue I confront every day – is often unexplained and unexplainable, a frustrating reality for patients.
Here’s another frustrating aspect of the experience that
patients must often deal with.
A patient with months or years of abdominal distress is seen
in an emergency room. In some instances,
there have been more than one ER visit for the same issue. Despite repeated laboratory data, a CAT scan or two,
other imaging studies of the abdomen, a thorough review of the patient’s
history and physical examinations which may be repeated over the course of hours in an ER, no diagnosis is made. The
patient is advised by the ER doc to consult with a gastroenterologist for an office
consultation to unravel the conundrum.
The patient then sees a specialist like myself – the
‘expert’- with the expectation that I will untie the Gordian knot and bring
clarity to chaos with a wave of my hand.
Indeed, it’s very natural for a patient to feel that seeing the
digestive specialist will be the key to unlocking the mystery of his abdominal distress. And there are many
times when I see patients referred to me from area emergency rooms that I sense
a new diagnostic angle to pursue or recommend medication modifications. But not
always.
Even though I have special training and experience in digestive
ailments, I face some handicaps that don’t exist in the ER. I'll explain. Which scenario would seem more likely to
explain a patient’s abdominal pain? An
ER visit with state-of-the-art technology with a team of medical professionals who
can assess a patient over several hours or a half hour visit with a
gastroenterologist who is equipped with knowledge and experience? In other words, if an ER or two can’t figure
it out, then we gastro specialists might be mystified also.
When I explain all of this to the patients I see sent from
ER’s, it makes perfect sense to them. I
still try to do my best for them. And, I
may have an advantage over the ER. Since
I have no available technology in my office to distract me, I have time to
really think over the case. There is
only the patient and me sitting in a quiet room as I meditate on the case. Imagine that, a physician’s brain being a
diagnostic tool!
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