Image credit: http://www.about.comI ran across this patient problem list the other day. This is completely real, but anonymized to protect the innocent:
- Probable occlusive coronary artery disease but fairly asymptomatic. Patient will return for a Persantine Cardiolite.
- Systolic murmurs consistent with mitral insufficiency and aortic sclerosis. She will return for an echocardiogram.
- Labile hypertension. We need to rule out renal artery stenosis. Patient will have a CT angiogram of her renal arteries.
- Historically occluded left carotid. I do not believe it with a lesion in the right. Patient will have a CT angiogram of her carotids.
- Chronic right-sided leg pain. She could have occlusive vascular disease in her lower extremities. We will do the CT angiogram of that as well.
- Ongoing tobacco abuse. I advised her not to smoke. She is not going to quit. She made that very clear to me.
- History of lung cancer. Treated with radiation therapy. No evidence of metastatic disease.
- Dizziness. Probably due to vascular disease. I do not think it is due to any significant arrhythmias. We will place a holter on her to be on the safe side, however.
At least she doesn't have kidney stones or the heartbreak of psoriasis. I'm thinking this little workup on this 80+ year-old patient is going to cost about $15,000+ or whatever Medicare will pay. Let's hope her kidneys hold up with all that iodinated contrast she's about to get.
Now you know how doctors think. Test every twinge, and if the test shows something, order more tests. I wonder why some still carry stethescopes.