If Facebook knows me better than my spouse, why does my doctor know so little?

A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of breath. He became unable to cook for himself and spent most of his time in bed, propped up with pillows. To feed himself, he spent the next six or so weeks ordering pizza delivery and eating it in bed, until his shortness of breath got so severe that he called 911 and came to the emergency room.

On the surface, my patient, a heavy smoker, had come in for a severe COPD exacerbation, someone who did not carry that diagnosis previously, but someone whose 60 years of smoking would make it no surprise. But in addition to the flare of his COPD, my patient was also retaining water with a flare of congestive heart failure, likely made worse by his subsequent increase in salt intake as he switched from his regular diet to take out. And finally, as he got progressively more short of breath, as he ate pizza while in bed, propped up, the risk of food or saliva occasionally ending up in his lungs, instead of his stomach increased, aggravating his respiratory problems even more.

This patient, like all patients who are sick enough to come to the hospital, had a variety of co-morbid conditions, some diagnosed, some not, which play a vital role in how patients will fare over time.

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