Mr. Smith was a sixty-eight-year-old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain.
“With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when it started, how long it lasted, how intense it was if it was still there.
His electrocardiogram hadn’t shown signs of an acute myocardial infarction (MI), or heart attack, and we drew blood to make sure there was no detectable damage to his heart. He received some heart medications and over several days waited while we “ruled out” an MI. The last step in that “rule out” included a heart “stress test,” which was not available on weekends and usually took days to obtain due to the high demand. Over the days that my patient waited in the hospital chest pain-free, our team got to know him as a person. We weren’t in a hurry to do a lot of additional tests for him — his plan was clear — he was doing well. The chest pain had resolved — we were just waiting for the stress test. But those days of waiting together gave us time to discuss his smoking and his blood pressure control. We lamented how the waiting for a test was frustrating. We guessed at how much money the system might save if that test were available much faster and Mr. Smith didn’t spend the extra days hospitalized.
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