We can't ignore what patients say

Before she began her medical career, the author learned firsthand about the dangers of basing a diagnosis on test results alone.

By Renate G. Justin, MD
Retired Family Physician/Fort Collins, CO

Laboratory and imaging tests are so ingrained in medicine today that it's hard to realize that many are less than 30 years old. Too much reliance on such things as CTs and MRIs, though, can lead to mistakes. We need to listen to patients, and use our judgment to evaluate how lab and other test results fit into and illuminate patients' stories. My own experience with flawed test results—and unnecessary treatment—is a case in point.

In the late 1940s, soon after I donated blood, the blood bank notified me that tests indicated I had syphilis. I knew this wasn't true, because I had never been sexually active and had never had a rash or a chancre. And both my parents had negative Wasserman tests, so congenital syphilis wasn't a factor.

Still, when I registered for medical school a short time later, I was told that I had to be treated with penicillin if I wanted to retain my place in the entering class. Because there was nothing I wanted more than to become a physician, I agreed to hourly penicillin injections (long-acting penicillin hadn't been developed yet)—knowing all the time that I didn't need the medication. I was embarrassed and angry: embarrassed to be admitted to the medical school hospital for treatment of venereal disease, and angry because no one believed me when I insisted that the diagnosis was a false positive.

Even after the treatment, I tested positive. It wasn't until several years later, when a new test for Treponema pallidum was developed and the old one discarded, that my physicians agreed that I was not then—nor had I ever been—infected with syphilis.

The physicians who examined and treated me relied on test results and ignored my story. It's easy to fall into this trap. We forget how many "absolute truths" we have abandoned, only to replace them with newer "absolute truths." We can all cite widely accepted procedures—such as pneumoperitoneum for tuberculosis—that have been jettisoned, and we are now questioning the usefulness of Pap smears for certain diagnoses.

Trusting our patients' stories is an essential part of good medicine and enables us to avoid mistakes based on laboratory evidence alone.

Renate Justin. We can't ignore what patients say.

Medical Economics

Sep. 17, 2004;81.