I called a friend in another state this morning to wish her 'Happy New Year". The woman said she had been ill for three weeks with the "flu" and diarrhea. I asked what treatment her doctor had prescribed and if she had had a chest X-ray. "Well", she said, "I haven't seen the doctor. He is very busy, so I have just seen his physician's assistant. The man said I didn't have pneumonia because my chest was clear." I told her about a sweet little girl I had seen who was ill with fever and a cough and no chest X-ray had been taken. The mother of the child also told me that the previous doctor hadn't heard anything in the child's chest so there wasn't any pneumonia. I knew the child had pneumonia because she was grunting. A chest X-ray showed a bad lobar pneumonia.
The physician assistant who saw my friend obviously didn't know that a pneumonia can be "silent." Since the woman has lost twelve pounds in the last three weeks, the doctor finally decided he needed to do something; he has ordered a CT scan of her chest and body for next week. This is very bad medicine and also expensive. Why doesn't he order a chest X-ray first, plus a stool culture because of the diarrhea, some anti-diarrhea medicine and maybe actually examine my friend? Is that really too much to ask? I suspect the doctor may be charging for his time when his PA is the one who has actually seen the woman. My friend thinks the doctor is "wonderful", so she will probably just go on getting poor care. If patients accept this kind of totally inadequate care, their lives can be dramatically and often fatally affected.