Extra Minutes

A 42-year-old woman came for evaluation of her treatment refractory neurological condition. After reviewing her extensive history, doing a detailed examination, and reviewing all her paraclinical tests including years of MRIs, I told the patient that I did not feel that she had the diagnosis that she was being treated for, and that she should come off the immune therapy she was taking given the risks associated with it. I said that I was not sure what she had, but that I would follow her very closely in hopes to identify what was causing her significant disability.

Keeping a keen ear

Over the following few visits, I collectively spent several hours face-to-face with her. Keeping a keen ear and spending extra time with her each visit paid off. It became clear that my patient had an extremely rare neurological condition that is often misdiagnosed especially early in the course of the disease.

Teasing out the underlying etiology

There are overlapping signs and symptoms with many conditions that often make it complicated to tease out the underlying etiology. The extra time I took with this patient, along with closely listening to what she was experiencing, helped me make the correct diagnosis and get her on the appropriate treatment path.

Falling behind can be worth it

I often fall behind in clinic because of spending extra time with patients; however, it is worth every extra minute when this leads to making the correct diagnosis and giving a higher level of care.