“We’re really at an infant stage in terms of our clinical ability to assess traumatic brain injury,” a medical expert said.
Before he ended his life, Ryan Larkin made his family promise to donate his brain to science.
The 29-year-old Navy SEAL was convinced years of exposure to blasts had badly damaged his brain, despite doctors telling him otherwise. He had downloaded dozens of research papers on traumatic brain injury out of frustration that no one was taking him seriously, his father said.
“He knew,” Frank Larkin said. “I’ve grown to understand that he was out to prove that he was hurt, and he wasn’t crazy.”
In 2017, a postmortem study found that Ryan Larkin, a combat medic and instructor who taught SEALs how to breach buildings with explosives, had a pattern of brain scarring unique to service members who’ve endured repeated explosions.
I was once almost killed by a doctor who wouldn’t believe me when I said I thought I had pulmonary embolism and sent me home without treatment, saying to “not use Google to diagnose myself”.
I’d be dead today had I not returned to see another doctor the next day.
I think if you name a suspected medical condition at the admission they are far less likely to believe you.
I know I’m a minority but as someone who works in emergency medicine I think the opposite.
If you come in thinking you have something there’s probably good reason, and I damn well better be sure you don’t have it if I’m going to send you home. You know your body better than me. It may not mean we test for it, but I need solid clinical decision making tools to support not testing for it
Usually that tool is that I’m a woman
It could be an embolism, but first let’s check to make sure you aren’t pregnant…
True, they might end up in prison for treating you…
I don’t understand, do you mean risk stratification in a specific clinical practice guideline based on gender?
I mean that doctors (emergency or otherwise) tend not to listen to me because I am a woman.
This changes when a (cis, white) man is present.
Happened to my ex wife, and I assume it keeps happening. She has Graves disease for years and told Drs something was wrong, but since she was heavy they just told her to lose weight.
It was left so long by the time they caught it that the cognitive decline that thyroid problems give you, were irreversible
Thats terrible :( I am so sorry
I’m sorry that happens to you. Unfortunately it’s a documented phenomenon (especially with rheumatologic diagnoses—I’ve explained that to residents a lot).
Here’s to hoping more attention to this leads to better education which can prevent it.
Thank you - and thank you for doing your part to educate residents!
That’s how it should be. It’s astonishing to me that some doctors don’t take the chance that the patient might be right
I just don’t understand how you can ethically practice with the opening assumption that your patient is wrong.
I get just as angry when staff get judgy about who goes to the ER when. Everyone defines their own emergencies. It’s why we’re there 24/7/365. For a lot of people we are the only no questions asked lifeline that’s always open (at least in the US)
Was also sadly my experience. Got a cut because of a collapse, told them that I have heart failure since a kid and this felt strange, but they never did any tests, just wanted to send me to the psych unit.
That was a pretty fucked evening…
What’s the rest of the story? (If you don’t mind sharing) This feels wildly incomplete.
Well, the doctor that sewed my cut was quite reasonable and I could at least leave.
All that happened because of an anonymous call, that I just had a long term relationship behind me.
Thing is, that they just ignored my initial report, as they immediately switched to the story of an anonymous caller. Which is a pretty shitty move
Anything more in details, and I’ll completely lose my pseudonymity, sorry
No worries, and thank you for sharing.
Yeah, you’re definitely in the minority.
It’s a shame too. A lot of this occurs due to the egos of medical professionals, rather than genuine concern that the patient might be going off the basis of misinformation.
I’m sure you think this and for people with decent insurance it may be true.
Never once have I ever received adequate medical assistance in my entire life.
Hell I was once even sent home with appendicitis AFTER testing confirmed it.
American for-profit medicine is a joke and untold people die from it every year.
#notanexpert . my understanding that ER/ED basically only have moderate responsibility to judge that you will not die and sue them in the next ~24h after an event. they tell you to seek further primary care when discharged.
The job of EM is stabilization and resuscitation. That takes a wide array of forms depending on your presenting condition. There is no “time limit” on what entails a safely dischargeable condition—if you present with chest pain, we CT you, and don’t find an immediately emergent cause of your chest pain, but in the process we fail to tell you about the lung nodule on your CT that turns out to be a CA that kills you in several years we are still liable. Maybe in certain states we are not medical legally liable at that point, but I would argue that we ethically still are. We are still all physicians (unless you’re getting treated by an APP).
In the context of stabilization and resuscitation I personally have the take that if you present with something I can’t adequately diagnose in the ED (let’s say I can rule out life threats but you still have a condition that is compromising your quality of life) then for the next step I really have to ensure adequate follow up for you (subspecialty referral, etc). That goes for the underinsured as well. It can get tricky, but that’s what case managers and social workers are for. Maybe I’m just biased because I work in academics. In general if you need emergency care I highly recommend that you go out of your way to get to an academic center because you’ll be more likely to get plugged in in this regard.
Thank the opioid era for that.
It’s only slightly worse now. The problem has always been bad, it’s just that a lot more people have had occassion to notice it now.
I was 25 when I was diagnosed with Ulcerative Colitis (IBD) I went down to A and E because I had bad swelling on my feet and I couldn’t walk at all, the doc told me it was muscular and have epsom salt baths. Next day swelling was worse so I made an emergency appointment with my GP who did tests and sent me to A and E for further tests. Basically after being admitted to hospital they realised that I had an infection from my ibd and I had lost a lot of blood that they gave me a transfusion. If I listened to the first Dr at A and E I could be dead now.
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Oh wow, yeah it would be tough to go to emergency care if it costed money. I hope that never happens in other places and you guys eventually get that fixed. There should be nothing stopping you or making you second guess if it’s a good idea to save your life.
ED bills are sent afterward in the US, we never have to think about it up front. It’s governed by a federal law called EMTALA. This led to some predatory “out of network” billing in the past which thankfully was shot down (in all things) during the Trump admin. It’s not perfect, but getting better.
I guess it’s just very difficult for the doctor if their interpretation of the evidence says that you are ok. They must choose whether to believe their patient, or to trust in their own knowledge and training. In your case, the doctor made the wrong decision and it almost cost you your life. And in other cases people definitely do die due to mistakes made by doctors. … or at least, the people would not have died if the mistake wasn’t make - that doesn’t always mean it was the doctor’s fault though. People are imperfect - especially when under pressure; and sometimes the strategies that save lives are the same strategies that let other people down.
I’m reminded of a TV series that I enjoyed, called “This is going to hurt”.