The life-changing importance of listening and attention

Lately, I have spent more time being a patient advocate than ever before. As physical therapists, many of us have the luxury of spending more time and getting to capture a thorough history and assessment of our patients. I know that this is sometimes not possible for many doctors—but the system needs to change.

I met a patient for the first time in mid-May. Her daughter had asked me if I could help her mom with this strange abdominal discomfort that started in January after she changed her workout routine. Despite “all blood tests and doctor’s examination not showing any abnormalities,” she was still feeling the pain and had not been able to go back to any type of activity. When I saw her early June and questioned about any other symptoms, she mentioned a low grade fever and general fatigue. She presented as super healthy and in amazing shape. Upon palpation of her abdominal wall I palpated a mass that felt like a softball. Internally, the mass was also palpable. Needless to say, I was greatly concerned and asked her to see her doctor ASAP, before I proceeded with any additional sessions. I did not want to be alarming since I am not in the position to make diagnoses; however, I tried to make sure she understood my urgency.

Here is a series of emails from her:

June 14, 2021. My doctor wasn’t available that day so I had a resident whom I hadn’t met before. She had your assessment and suggested that I have a vaginal scan. But she had to confer with a more senior doctor before setting anything up and she told me he said not to do it, that I really couldn’t have fibroids. I didn’t see him. After the resident conferred with him and returned, she pressed around on my abdomen and said she didn’t think there were any problems. If the swelling doesn’t go away or things take a bad turn, I will get a second opinion.

I called her and told her that I was not okay with that, and begged her to go and see another doctor that I arranged for her to see within two days. The new doctor sent her to ER that very same day, and two days later she was scheduled for surgery to remove the mass.

July 6, 2021. Although we were elated that the mass removed from my abdomen did not show cancer, the final pathology report did show cancer: endometrioid carcinoma in the right ovary and right fallopian tube and on the back part of the uterus. It is stage 1 cancer, but my doctor said it was elevated to stage 2 because the cancer was in two locations. I see a chemo doctor tomorrow and should start treatments soon. 

July 14, 2021. My appointment with my chemo doctor went very well and I feel fortunate to be working with him and his team. 

July 23, 2021. I am okay. I had my first chemo treatment yesterday and a few minutes in I reacted badly to the medication, so they stopped the treatment. I meet with my chemo doctor on Monday to work on Plan B. Otherwise I feel good – recovering well from the surgery and looking forward to being more active soon.

It is a real shame that her symptoms were dismissed and an obvious palpable mass was diagnosed as a “swelling”—what if she had waited longer? What if a doctor had diagnosed her much earlier? What are we doing wrong in our medical system?

People trust their medical teams and put their lives/faith in our hands. Thank goodness for the wonderful doctors that I know and trust and can refer to at the drop of a hat. But what happens to those who do not think to question what they are told nor have someone to advocate for them? This just breaks my heart. We need to be better and remember our most basic duty—to put patients first.

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