Nursing Notes

October 13, 2010

How do so many journalists miss it?

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This article originally appeared in The Washington Post, but I found it on one of my favorite websites, The Truth About Nursing.  This article is stunning in that a nurse was able to use common sense and experience to help a patient after numerous specialists were stumped.  I wondered, after reading the article, if any of these physicians ever really looked at the patient or asked him any questions about his life and locale.

I simply saw the picture and knew he had Lyme’s Disease, but I live in an area where ticks and deer are plentiful.  Maybe, in the defense of the doctors, they had never been in an area where either of these two organisms are found and therefore knew nothing about them.

Please read the entire article and leave them a comment if you feel like it.  There are many wonderful articles and stories to be read on that site.  I hope you enjoy.

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bulls-eye rashSeptember 27, 2010 —  Today The Washington Post published a lengthy entry in its “Medical Mysteries” series headlined “Nurse solves mysterious ailment that puzzled orthopedists, oncologist.” Sandra G. Boodman’s piece describes a local man who spent more than a year consulting various specialist physicians, enduring “two unnecessary knee surgeries and dozens of physical therapy sessions, as well as acupuncture and other useless and sometimes painful treatments that cost thousands of dollars,” before “a nurse” at an infectious disease specialist’s office suggested that he might have Lyme disease. He did. You might think, then, that the article would be a tribute to nursing expertise, but instead the central fact of the story is overwhelmed by disrespect for nursing. It’s not just that the piece repeatedly dismisses what the nurse did by calling it “simple” and “obvious,” “a basic query by a nurse, not the acumen of five specialists.” No, the most striking thing is that in this 1,300 word story describing all the erroneous thinking of the “specialists,” the nurse who actually solved the problem is never named, quoted, or further described. It’s true that none of the specialists are named or quoted directly either, which certainly protects them from embarrassment. And it seems that the approach of these pieces is to rely mainly on the patient’s account; perhaps this patient never actually met the nurse, though he says he “remains grateful” to the nurse. But the piece does name and quote an infectious-disease expert the patient consulted after the diagnosis, so it might have done more with the nurse, even if could not give the nurse’s real name. The net effect of what we do have here is to suggest that the nurse solved the problem by being so simple and limited, with a mind uncluttered by real expertise. Needless to say, there is no suggestion that maybe the nurse solved the problem because of her own expertise, or the nature of nursing, including the profession’s holistic and flexible approach, which is no less “expert” for being broad. The piece pokes fun at the specialist physicians, but it still reinforces the idea that they are the main source of health knowledge–the same idea that seems to have gotten this patient in so much trouble.

This is the story of John Gordon, the 54-year-old president of a commercial real estate firm. Gordon thinks he might have been better off “had his office not been located in a Montgomery County high-rise that also houses many medical offices,” which made it convenient for him to see all the specialists there. Gordon, “whose father and father-in-law were doctors,” says he did not ask enough questions, and was “too good a patient,” which must mean accepting whatever physicians say–hardly surprising for a person with that background. The result, apparently, was “two unnecessary knee surgeries and dozens of physical therapy sessions, as well as acupuncture and other useless and sometimes painful treatments that cost thousands of dollars.” This part of the article hints that we should not be so trusting of specialist physicians. But then we get this:

In the end, it was a basic query by a nurse, not the acumen of five specialists, that led to the correct diagnosis of a common malady. “If you don’t ask simple questions, you screw up,” Gordon said. “I see that in my business all the time.”

The piece traces the history of Gordon’s problem, which appeared in 2007, when he first noticed that his knee was swollen. He consulted an orthopedist, who recommended physical therapy. That did not help. The orthopedist drained the knee and gave Gordon cortisone shots. That did not help for long. An MRI showed no torn ligaments or cartilage, so the orthopedist recommended exploratory surgery. A surgeon operated, “told Gordon he had a partially torn meniscus, a common injury involving cartilage,” and then “repaired the cartilage.” That did not help.  Gordon consulted a physiatrist, who specializes in rehabilitation and pain management. This physician considered whether it might be an infection, but assumed that had been ruled out, and suggested acupuncture. That did not help. Gordon got a second MRI, and his orthopedist suggested surgery for “pigmented villonodular synovitis, which causes an overgrowth of tissue for no apparent reason.” Gordon switched orthopedists but had the surgery. It did not help. The surgeon suggested that the abnormal tissue in the knee pointed to cancer, and referred Gordon to an orthopedic oncologist and an infectious-disease specialist. But the tissue biopsy was negative.

The infectious-disease specialist confidently suggested that Gordon had contracted “valley fever,” a serious fungal infection, from a recent trip to the Southwest. Gordon took “the maximum dose of a potent antifungal drug” for two weeks. It did not help, but it did make Gordon “feel weak and very nauseated.” The infectious disease specialist was stumped, though that did not stop him from prescribing an antibiotic.

But a week later, in June 2008, the doctor called back. Gordon said he reported that during a staff meeting at which his case was being discussed, a nurse asked whether Gordon had ever been tested for Lyme disease.

nurse-physician discussionGordon said he had not, and that “no one had mentioned it.” We’re actually impressed that the physician admitted that this was the nurse’s idea. Physicians often receive credit for life-saving nursing ideas and observations, whether because physicians present the ideas to patients as their own, patients assume they must have been the physician’s idea, or nurses hide their own role. Of course, it’s also impressive that this specialist’s office had meetings in which a nurse’s professional opinion was considered. Physicians routinely leave nurses out of discussions of diagnosis and treatment, even though nurses’ input can mean the difference between life and death. Nurses must often use complicated social dances to have their views considered. Naturally, the Post article explores none of this, though it certainly would be worth discussion in a major newspaper.

In any case, the infectious-disease physician faxed an “order” for the test, which was positive. The disease was responsible for Gordon’s knee problems. The piece gives some basic information about Lyme disease, which is “a bacterial infection caused by a deer tick bite.” Lyme arthritis is “sometimes permanent.” Gordon was “stunned,” and wondered how this could have been “missed by so many specialists.”

For some answers, the piece turns to “Adriana Marques, an infectious-disease expert at the National Institute of Allergy and Infectious Diseases who is studying the natural course of Lyme…[read the rest of this article]

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3 Comments »

  1. Wonderful post here,I really enjoyed reading this.Thanks for posting.

    Comment by Kyle — October 13, 2010 @ 8:02 am | Reply

  2. How do so many journalists miss it?…

    I found your entry interesting do I’ve added a Trackback to it on my weblog :)…

    Trackback by World Wide News Flash — October 13, 2010 @ 8:37 am | Reply

  3. that is very true..i too read the article found it interesting and have forwarded to my friends who would be interested…

    Comment by Edwin — October 20, 2010 @ 8:53 am | Reply


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