Hard Cases: What Happens When a Medical Mistake Has an Unthinkable Outcome

Treating an older man who seemed to like me and whom I thought was dressing up for me made me uneasy. I was flattered but also anxious about feelings that I didn’t want to bring into a patient-physician relationship.

When his routine blood tests came back with a low red blood cell count, I presented his case to my attending physician. I don’t remember the details of Mr. H’s workup. But I do remember that I did not do a rectal exam to check for masses and for hidden blood in his stool, a sign for colon cancer. My anxiety about the basic, but personally invasive, examination got the best of me.

Would I have felt this way if I had been treating a woman instead of a man? No. I would have just gone about my business, conducting a thorough history and physical examination, including a rectal examination. But I didn’t do that for Mr. H. And now he had colon cancer.

Medicine is about objectivity and emotional connection not just with selected patients, but with all of our patients –no matter what. The problem is that many of us have treated, and continue to treat, patients differently according to their looks, their political beliefs and their insurance status – but we don’t want to admit it.

If Only You Had Looked for Blood in My Bowel Movements