Poison Pill

I am trying to catch up the world news and events, as I lay on my parent's blue couch surfing the Internet (thanks to the wifi set-up in our house). I am instantly drawn to a NY Times article titled "Poison Pill" written by Lisa Sanders.

In the diagnosis article, Sanders follows a medical resident as she admits an 81 year-old woman that presents with hypotension, difficulty breathing and a fever. Her labs revealed a drastic decrease in her white blood cells, the cells needed to fight off infections, a condition called "bands."

If you put the three symptoms together- hypotension, fever and bands- you have got a formula for septic shock. Essentially in septic shock, your body is mounting a reaction against some type of invader, it's usually bacterial, viral or something you are allergic to. So, until the culprit is identified, powerful and high dose antibiotics are administered.

In this case, lab tests searching for an infectious agent proved negative. But there was still something that had caused the allergic reaction. A careful patient interview would be the key to revealing the source of her reaction.

The patient had taken quinine, a drug to treat muscle cramps. And although she had taken a small amount, the resident suspected the patient had some sort of previous exposure and allergic reaction to quinine. And she did; she had drank tonic water (which contains a small amount of quinine). Her bloodwork revealed she was, in fact, allergic to quinine.

By relying on the patient's history, the resident was able to piece together the mysterious diagnosis that lead to the discovery of the patient's "poison pill."

Sanders echoes this sentiment by reflecting on the principles of Sir William Osler.

"Sir William Osler, the father of modern medicine, taught his students that the patient’s story will often contain the key to making a diagnosis. It was important advice at the turn of the 20th century, when few diagnostic tools were available. And it is still true, as research shows. Even now, 75 percent of diagnoses are based on the patient’s story alone. 'Listen carefully to the patient,' Osler exhorted. 'They will tell you the diagnosis.' You just have to pay attention."

The lesson here is clear- listen to your patients and you may just find out what you are looking for. I'll be keeping this in mind in the years to come...