A Negative Workup

Jonathan Blake is a hardworking 62-year-old janitor, who seldom complains. A few weeks ago I got several hospital reports about him.

He had gone to the emergency room with pain in the upper left portion of his chest, radiating down his left arm. He is a diabetic, who takes blood pressure and cholesterol medications, and he smoked cigarettes until five years ago. Needless to say, the hospital kept him overnight because he seemed such a high-risk patient for coronary artery disease, and put him through a stress test the next morning.

His nuclear stress test was normal, so he was discharged with a diagnosis of “non-cardiac chest pain”.

Almost two weeks later I happened to see his name on the computer screen at my workstation. Jonathan was in to see my colleague, Dr. Wilford Brown, who often sees patients the full-time doctors at our clinic cannot fit into their schedules. I always have full confidence in Dr. Brown’s ability to handle any situation, which also turned out to be the case this time.

I forgot about the whole incident until a few days later, when I, as Jonathan’s PCP (Primary Care Provider) had to sign an insurance authorization for a shoulder MRI. A few days later the MRI report arrived. Jonathan had torn a large portion of the rotator cuff of his left shoulder and he had also torn the long head of his biceps tendon.

Last week I saw him for his regular diabetes follow-up. By that time, he had already seen the orthopedic surgeon who will be repairing his rotator cuff. Jonathan showed me the telltale bulge in his upper arm, where the useless biceps muscle had contracted. At his age, that particular injury isn’t usually repaired, but the rotator cuff is essential.

“I can’t believe they didn’t pick this up at the hospital”, he said. “They didn’t listen to me. I told them all along my arm hurt, and all they worried about was my heart.”

1 Response to “A Negative Workup”

  1. 1 Steph December 29, 2008 at 8:58 am

    That is worrying.

    However, a clue to what happened in the emergency room could be that “Jonathan Blake is a hardworking 62-year-old janitor, WHO SELDOM COMPLAINS.”

    Perhaps he under-emphasised the nature of the pain in his shoulder leaving staff to wrongly conclude that his problem might be cardiac in origin. It does seem amazing that nobody thought to carry-out a physical examination of his shoulder movements.

    Well done (again) to Dr. Brown!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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