An excerpt from Doc, What’s Up?
It’s been said that we only see what we are accustomed to seeing. In the case of highly trained medical specialists, the same must certainly apply?
At only 32 years of age, Roger X was stunned to find out that the cause of his episodic bouts of weak- ness were due to a heart problem—angina pectoris. At the time of his diagnosis, coronary by-pass surgery was not readily available since it was still considered experimental. He was placed on nitroglycerin tablets to relieve his attacks and told to take it easy. Hopefully, he’d live another five years.
Roger lived in a small Northern Minnesota town where he earned his living making fishing lures in his basement. He was married and had two young children. He was active in his church and was a solid, respected member of his community. Naturally, he became severely depressed about his diagnosis and his prognosis.
I saw Roger as a patient about a year after a prominent St. Paul cardiologist had made his fateful diagnosis. I asked him, as I normally do with my new patients, to recant his symptoms. As I carefully listened to him, I found myself a bit unsettled with the diagnosis he’d been given. Frankly, his symptoms sounded suspiciously closer to hypoglycemia than they were to angina.
I decided to follow my hunch. I asked him to take a simple, harmless, five-hour glucose-tolerance test.
Sure enough, Roger’s blood sugar plummeted three hours after ingesting a large sugar drink and his weakness and sweating symptoms recurred. Rather than angina, Roger had reactive hypoglycemia—an uncomfortable, but otherwise, harmless, treatable condition.
By the way, all the tests showed that Roger’s heart was normal.
Full of myself, I asked Roger to come in to my clinic so I could break the good news in person. When he arrived, I couldn’t contain my enthusiasm as I told him,
“Roger, you know sometimes these high falutin’, city slicker specialists know zilch about making a correct diagnosis. You haven’t got angina! You have a garden-variety disorder called hypoglycemia, which has some of the same symptoms as angina but is infinitely less serious. Not only that, hypoglycemia is easily cured by changing your diet. Actually, you are quite healthy!”
His initial reaction was total disbelief. How could a famous specialist be so wrong?
So, I showed him the glucose-tolerance test results, which corroborated my diagnosis. His “attack” had coincided exactly with the drop in blood sugar after he’d taken the sugar drink. It was hard for him to deny the boldfaced reality.
“There’s nothing wrong with your heart, so you can forget that bunk that the specialist fed you.” Then, in my normal joking demeanor, I added, “You’re healthy enough to run off with an eighteen-year-old!”
I saw Roger once more about two months later. He’d been rigorous about maintaining a low carbohydrate diet and had no further attacks of weakness. He had become a believer.
The last I heard of Roger was that shortly after our last visit, he’d run off with another woman, abandoning his wife and children for parts unknown. I wondered if my new diagnosis had been, in part, the instigation for his extreme behavior. Or had he actually taken my joke as a recommended treatment? From that point on, I became a bit more conservative in breaking such radical news to my patients, whether it is good or bad, but I haven’t let up on the jokes.
Stephen Zuckerman 