Should my Gallbladder be Removed?

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Why is the medical history – the patient’s narrative – so critical?  I have opined in this blog repeatedly that the medical history is paramount, much more valuable than the physical examination or the laboratory and other data.  Of course, there are instances when a finding on the exam or abnormal data cracks the case, but in general, the patient’s own story is most significant most of the time.

Indeed, medical professionals, if we are not being careful, can permit abnormal data results to lead us to a trap door which will take us far away from where we should be.  Consider this to be a medical ‘wag the dog’ phenomenon.  Our focus should be squarely on the patient before us.

Here’s an example of a physician distraction which I have witnessed multiple times in my career.  I am sure that I have also been lured to a trap door or two over the years. 

A patient comes to her doctor complaining of stomach aches.  The doctor prescribes a medication which is not helpful.  So, an ultrasound of the abdomen is ordered and gallstones are discovered.  The patient is then referred to a surgeon who removes the gallbladder.  Although the procedure is performed flawlessly, the patient’s pain persists afterwards.  Clearly, the gallbladder was not the culprit.  What happened?

Abdominal pain comes in a myriad of versions.  It can appear in every region of the abdomen.  It can be a dull ache or an intense stabbing.  It can last for minutes or hours.  It can be associated with other symptoms such as nausea or back pain.  Indeed, evaluating abdominal pain is complex and takes time to tease through the history.  This careful deliberation is the key to the evaluation. 

Gallbladder pain causes very characteristic symptoms that physicians are familiar with.  (Of course, there are always exceptions, but let’s leave this aside for now.)

And gallstones are extremely common.  The majority of individuals with gallstones never need to have their gallbladders removed – the gallstones are simply innocent bystanders.

Gallstones - Culprit or Innocent Bystander?

Here’s the trap door.  If a doctor orders an ultrasound of the gallbladder on a patient with abdominal pain inconsistent with gallbladder pain, and gallstones are found, then they can be erroneously assigned the blame.  This patient may soon find himself in the operating room.  Such a patient will soon have no gallbladder but will still have abdominal pain.

There is no guarantee that an operation or a medical treatment will be successful, even when advised by thoughtful practitioners.  Physicians engage in serious due diligence, relying upon our knowledge and experience to maximize the probability of therapeutic success. Maximizing does not mean guaranteeing.

Although I have used the gallbladder vignette to illustrate my point, trap door phenomena occur in all medical specialties.

Yes, I have fallen through some trap doors in my career.  I do my best to listen carefully to the patient’s story to minimize the risk that the patient and I will find ourselves in free fall as the trap door flies open.