Taking time with patients more beneficial in the end

Published: 9/20/2010 9:18 AM

Medicine is constantly changing. One area that is garnering a lot of attention is how medicine can become more efficient, especially with how physicians interact with patients.

Although there are areas that can be improved, medicine is not an assembly line and people are not cars. Sometimes the best way to practice medicine is to take the time to listen and think, which is not done in the usual 15-minute office visit.

When I was in medical school, we learned about physiology, biochemistry and anatomy. We were taught how to integrate these disciplines, arrive at a diagnosis and formulate a solution. When we became residents in the hospital, we were strongly encouraged to adopt an algorithm - a type of thought process (flow charts) because it was faster and more efficient. Although this type of thinking might work well for car repairs, algorithms greatly limit diagnosis and treatment options because many chronic medical conditions do not easily fit.

A patient came to me about three months ago. She was complaining of severe hives, a 13-year history of chronic fatigue symptoms and anaphylactic shock (severe allergic reaction). She also had complaints consistent with interstitial cystitis, irritable bowel and fibromyalgia. For over a decade, she had been seen by numerous physicians including the Mayo Clinic. She was told that she was histrionic and depressed. None of her symptoms fit the common algorithms.

I found her disparate symptoms to be challenging, until I learned that everything began soon after she returned from rural Costa Rica and Nicaragua. I immediately thought parasites and ordered some blood tests. Chronic parasite infections can cause many different symptoms including cystitis, chronic fatigue, hives and even anaphylactic reactions. At the second office visit, I learned that, for years, there was a growing cyst in her liver and her sister, who lived with her in Costa Rica, also has cysts in the brain again a possible indicator of parasites.

The patient was recently referred to the University of Illinois Medical Center. She told the physician there of her concern about a possible parasite infection. Since this type of parasite infection is rare in the U.S., like so many times before, my patient was dismissed without a specific diagnosis.

I recommended Dr. Patricia Larson, an infectious disease specialist at Alexian Brothers Medical Center. Larson took a lot of time with her and based on her history, physical and earlier diagnostic tests, a parasite infection is on top of the list of possible causes.

There are no easy algorithms that encompass all of these symptoms. A doctor has to go back to physiology, immunology and microbiology to make the diagnosis. That takes time and, in an algorithm-based medical world, would seem to be inefficient. However, this "efficient" approach has resulted in hundreds of thousands of dollars in unnecessary medical costs and a lost decade of life for my patient.

Dr. William Osler, father of modern western medicine, once said "The good physician treats the disease; the great physician treats the patient who has the disease." Rather than focus on efficiency, maybe we need to take the time to create great physicians.

• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network.