Dissecting aneurysm of the aorta. Internet image.
By Paul Goldfinger, MD, FACC Editor Blogfinger.net.
Re-post from 2018.
The simple answer is yes, and it often has to do with fear of harming a patient either through what we do to treat a disease or through missing a diagnosis.
A basic tenet of medical practice is, “First do no harm.” During my career I thought of that warning many times, because a physician is often tempted to do something that might be risky. Oftentimes that concern is more than balanced by the potential to help a patient—-even to save their lives.
I think that certain diagnoses also strike fear into the hearts of doctors. In my years as a cardiologist, the condition which worried me the most was dissecting aneurysm of the aorta. This is a life threatening emergency which usually affects men, ages 60-70, but anyone could be a victim. The aorta is the large blood vessel that leaves the heart to carry oxygen-rich blood all over the body and especially to vital organs such as the brain and heart.
A tear develops in the aorta, for a variety of reasons, and the wall of this large artery begins to split apart lengthwise and may even rupture. The condition usually develops suddenly and evolves quickly, resulting in high mortality rates.
Aside from the obvious risk of such a catastrophe, one of the fearful elements of it for the physician is that the signs and symptoms can be varied and difficult to figure out, and the chance of survival improves when treatment is initiated as soon as possible. For example it can mimic a heart attack or a stroke. Very often it produces excruciating mid or upper back pain, and whenever I would get a call from the ER about someone with such pain, a knot in my stomach would quickly develop. Oftentimes the varied presentation of a dissecting aneurysm would fool the doctor and send him down the wrong path. My greatest fear was to miss the diagnosis.
Occasionally this dangerous condition would present with no pain at all—-just other symptoms like nausea or sweating or shock. I recall one patient whose sole initial symptom was fainting accompanied by a very slow pulse, initially causing us to misunderstand the situation.
If a doctor experiences fear, it is often alleviated by the certainty of experience, knowledge, a correct diagnosis, and a hopeful treatment plan.
Another source of fear is when the doctor is involved in a surgical procedure which goes wrong. But experienced surgeons often don’t have fear during such situations because they are trained professionals who react reflexly to correct a problem. I worked with a surgeon at Dover (NJ) General Hospital and Medical Center who had been in a front line surgical unit in Viet Nam. There was nothing that would scare him.
The best defense against fear is competence and character, and that is why a solid education during medical school and during post-graduate training at quality institutions is so important and why patients need to look at their doctors’ credentials.
Gen. George Patton said, “All men are afraid in battle. The coward is the one who lets his fear overcome his sense of duty. Duty is the essence of manhood .”
And so it is for physicians who must put aside their fear and go ahead and protect their patients.
As for dissecting aneurysm, new diagnostic imaging methods and new treatments now available, including non-surgical approaches, provide reassurance for the doctor and the patient during this dangerous problem.
CARTER BURWELL “The Deer” from the movie “3 Billboards Outside Ebbing, Missouri.”
