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On Being a Doctor |

In Transition

Albert K. Luo, MD
[+] Article and Author Information

From Stanford University Medical Center, Stanford, CA 94305.


Requests for Single Reprints: Albert K. Luo, MD, 300 Pasteur Drive, Grant S101, Stanford, CA 94305-5109; e-mail, aluo@stanford.edu.


Ann Intern Med. 2010;152(5):330-331. doi:10.7326/0003-4819-152-5-201003020-00014
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On a Sunday late last March, I admitted Mrs. M to the general medicine service—my final admission on my final medicine rotation as a medical student. She arrived with three specific symptoms. One, her left leg had swollen over the past 2 weeks so that it was now twice the circumference of her right leg, from hip to ankle. Two, over the past few days, she felt short of breath even doing the most basic activities, such as tying her shoelaces. And three, although her appetite was still strong, she felt full after just a couple of bites of food and her belly had become noticeably distended, also over the past few days. She hadn't seen a doctor in more than 20 years; she hadn't had to, she said, because she'd never been sick. Widowed, she lived alone, with occasional but regular visits from her children and grandchildren. Her swollen leg, painful and tense, finally drove her to call an ambulance.

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In Transition
Posted on March 24, 2010
Jonathan B. Shammash
Englewood Hospital and Medical Center, Englewood, NJ
Conflict of Interest: None Declared

I enjoyed Dr. Luo's vignette, and I appreciate his apprehension about communicating his patient's diagnosis to her in the middle of the night. I would disagree, however, that he "chickened out" by waiting until morning to deliver bad news. It is often difficult for us as physicians to know about bad news for our patients and to withhold it until we feel it is the most appropriate time to tell our patients. While he states that the patient was likely apprehensive about the results of her CT scan, there was little he could do for her in the middle of the night. Second, Dr. Luo states that he was post call, so he went home before his attending delivered the bad news to the patient. Unfortunately, it would have been beneficial for him to stay and observe and/or participate in that discussion with his patient. He was not likely under duty hours restrictions, and therefore could have chosen to stay. That said, it is easy to have "20/20 hindsight." I applaud his courage in telling his story so that other physicians and health care professionals might reflect on it.

Conflict of Interest:

None declared

No medical care for two decades
Posted on April 18, 2010
Linda L. Isaacs
No Affiliation
Conflict of Interest: None Declared

I appreciated Dr. Luo's vignette; I remember admitting a similar patient as an intern. However, I wish he had not emphasized her failure to see a doctor over the preceding twenty years. Had her diagnosis been colon cancer I could see why this would be relevant. Given that she was found to have ovarian cancer, had she been seeing doctors she might well have reported a history of vague abdominal complaints dismissed by multiple doctors, followed by the exact same presentation to the hospital.

Conflict of Interest:

None declared

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