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Rock, Paper, Scissors

Article  in  Journal of Patient Safety · November 2016

DOI: 10.1097/PTS.0000000000000285

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 TIPS FOR SUCCESS
Rock, Paper, Scissors
Jacob Adashek, BA
B ig and burly, strong and stoic, a salt-of-the-earth sort of man,
he is both my dad and best friend in one. My rock.
Road trips for basketball tournaments, sporting events, and
nightly walks while conversing of subjects significant and trivial
were our past times. The comfort of knowing he would be there
day or night, until he almost was not.
Friday night in medical school meant the treat of dining out and
then back to the grind of studying. Being a creature of habit, I
called my mom and we chatted, but I felt uneasy with a tone I
heard in her voice. “Where are you?” I questioned. Silence and
a nervous throat clearing before she responded, “the hospital.”
Frustration at being kept in the dark welled within me. “What hap-
pened? Why didn't you tell me you were at the hospital?” I asked.
She quietly explained. “You have enough on your plate, and I
know you have a big exam; I was planning on telling you when
I knew something.”
Being a student, I have limited medical knowledge but wanted
to be brought up to speed on what was transpiring. He had sharp,
stabbing pain below his left rib cage, chest pain, and soreness
above his left shoulder, severe enough to send him to the emer-
gency department (ED). The electrocardiogram came back nor-
mal, as did his laboratory test results. The attending physician
was leaning toward costochondritis. I asked my mom to request
a D-dimer; she was told it would be done with the blood work.
It was a relief to hear Dad was cleared for discharge. Instructed
if anything changed for the worse to return and told to take ibupro-
fen for pain.
Something was not right. The next day I needed to focus on
studying, but checked in frequently with both parents. His pulse
and blood pressure were elevated; I had him put an app on his
iPhone to check them. However, it was his description of discom-
fort that did not sit right or seem musculoskeletal. My nagging
feeling remained almost 48 hours later. I strongly urged him to
go back to the ED. He hemmed and hawed, but my parents heeded
my plea and returned.
The symptoms were identical, nothing additional. A second
electrocardiogram came back fine once again. This evening's at-
tending physician immediately had 3 differentials: pleurisy, pneu-
monia, or pulmonary embolism. My mom kept me updated in real
time. I had questions, among them, if certain tests could be run.
The attending physician on this visit was very receptive and of-
fered to talk with me by cell phone. I felt somewhat hesitant to
overstep boundaries, but his graciousness relieved me. He per-
ceived my concern and readily discussed my requests. Dad was
wheeled away for a computed topographic scan. The possibility
of pulmonary embolism made my stomach flip-flop; I hoped for
something less threatening. Rather quickly, the results came back:
pulmonary emboli in both lungs. Dad was admitted to the hospi-
tal, and that was when paper covered rock.
From the Western University of Health Sciences, College of Osteopathic Med-
icine of the Pacific, Pomona, California.
Correspondence: Jacob Adashek, BA, Western University of Health Sciences,
309 E Second St, Pomona, CA 91766 (e‐mail: jadashek@westernu.edu).
The author discloses no conflict of interest.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
J Patient Saf • Volume 00, Number 00, Month 2016
Copyright © 2016 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
The ED doctor and I spoke for the second time that evening,
and I asked that Dad be put on a particular medication; he
expressed it was his drug of choice as well. Within minutes, we
had a problem. The hospitalist was called in since Dad would be
admitted. As the well-known child's game goes, rock prevails over
scissors, but paper covers rock. The “piece of paper” or degree of
the attending hospitalist had trumped my being only a medical stu-
dent, and he made sure everyone knew it. It was clear this doctor
wanted no input from me.
This was my dad, my rock, my best friend; and I desperately
wanted what was in his best interest. I respectfully requested the
same medication approved by the ED doctor, but he was insisting
on another. We finally agreed to do it his way (what choice did I
have?) until the morning when he assured me a metabolic panel
would be repeated. His promise was not kept just as the D-dimer
was not run at the first visit.
The next day was far better with the discharge doctor who im-
mediately switched Dad to the medication I had asked for from the
start. I learned a valuable lesson but not a pleasant one. I was
dismissed by chain of command and being right did not matter
at all.
The helplessness I felt that night was compounded by a physi-
cian who seemed more concerned with getting “his way” than
with his patient's best interest. Additionally, he would not pre-
scribe a painkiller, telling my parents that the possibility of addic-
tion was real and ibuprofen could be used. My father does not
even drink alcohol, and there was no reason to deny him pain re-
lief. When Dad's internist learned of this 2 days later, she shook
her head in disbelief and prescribed oxycodone. The hospitalist
exemplified what not to do when interacting with a patient, their
family, and in general, as a medical provider.
This hospitalist's inappropriate demeanor was the smaller of 2
failures by 2 physicians in charge of my father's care. As an aspir-
ing doctor, I was disheartened. The first attending ED doctor had
missed the boat, dropped the ball, whatever you name it. His mis-
steps put my dad's life in jeopardy. Sending my father home may
have been fatal. Had the D-dimer requested been done, my dad
would not have gone through additional days of pain and the very
real risk of death from lack of treatment.
It can be argued that the second ED physician had the ben-
efit of a second visit to the ED; however, nothing new had
presented. It can be debated that the first physician did not or-
der a computed topographic scan because of exposure to radi-
ation and contrast. It then becomes a case of risk versus
benefit. It can even be offered that the symptoms were not
“text book”. The question swirling in my thought process is
how 2 doctors assessing identical patient symptoms took 2 such
different approaches.
Dad survived; Mom feels grateful. Despite being prematurely
discharged from the ED with an incorrect diagnosis, my mom
now says, “Well, doctors are human too.” Had the outcome been
different, she admits that would not be her sentiment.
The medical school I attend stresses the fact that we are lifelong
learners. This unfortunate occurrence validates the importance of
taking lifelong learning to heart. As medicine evolves and our
knowledge expands, some things remain the same. Vigilance,
www.journalpatientsafety.com 1
 Adashek J Patient Saf • Volume 00, Number 00, Month 2016

perseverance, a strong work ethic, decency, and devotion are es-
sential. The very same traits my father felt important to instill in
his children.
One patient of many on a busy night in the ED, but to me, he is
my rock, my dad. “To the world you may be one person, but to one
person you may be the world.”1
Rock, paper, scissors. Rock, each patient may be someone's
rock, their world. Paper, you are entrusted with the degree for
the betterment of your patients. Lastly, scissors, to cut to the chase
and “when you hear hoof beats, think of horses not zebras.”2 A
true trifecta to adopt and remember while continuing my training
as a future physician.

1
Theodor Geisel
2
Theodore Woodward

2 www.journalpatientsafety.com © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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