An excerpt from Treating a Broken System: A Physician’s Cure For the Healthcare Crisis.

Let me take you back to the Philadelphia suburbs in March 1997. My wife, Terry, and I had been married for almost twenty-one years, and we had three children, all teenagers. Terry had not yet completed her bachelor’s degree when we were married in May 1976. She went on to accomplish that when the kids were in school full time, and then was working on her PhD thesis in neurobiology in 1997. I was a professor of general internal medicine at that point. Terry had a history of migraine headaches, usually preceded by a visual aura, that is, flashing lights and an area of white light when looking at objects. One night she woke me up saying that she had a migraine, but it was different than the others that she had. She noted that her left arm was rhythmically bending and straightening before she got the headache, and that she couldn’t control the movements. Migraines can change when we age, and I thought that hers just did so. I didn’t want to believe that anything else was going on. But I made an appointment for her to see a neurologist where I worked the next day.

When we saw the neurologist, I told him what had occurred, and told him I thought it was a transformation of the migraine with a motor area aura, which can occur especially in patients approaching menopause. The neurologist talked with Terry and then performed a thorough neurologic examination, which was completely normal. He also concurred with my diagnosis, but said that he wanted to get an MRI when we could schedule it. I arranged for the MRI to be done a few days after our appointment with the neurologist. I took Terry to the MRI appointment, and then after the test, dropped her off at home as I had to go to work.

Sometime that afternoon I received an urgent call from Terry. She was sobbing, and it was difficult for me to understand what she was saying. I couldn’t calm her down, so I told her to just sit down and I would be home as soon as I could. It usually took me about 30 minutes in traffic to get home from where I worked. That afternoon I am sure it was no more than 15 minutes. When I got home, Terry told me what the neurologist had said. She said that “he had the results of the MRI, and it shows that there is something white” in her brain. Terry explained to the neurologist that she is a neurobiology doctoral candidate and knows that the brain has white matter. He replied that this was different. There was something white where the gray matter was. Being astute, Terry asked if it was a tumor. He said, “I don’t know, just go see a neurosurgeon as soon as you possibly can.” He gave Terry the name and number of the neurosurgeon and hung up.

I then took Terry to the neurosurgeon, who also talked with us and did a thorough neurologic examination. He then put up Terry’s MRI films on a light board used to examine X-rays, CT scans, and MRI scans. He pointed to an area on the MRI films and said, “This is the tumor in this projection, and here it is in this projection. It’s probably a grade III astrocytoma. We can do a biopsy, but I would recommend that we remove it instead and give you another year or two of life.” Terry started crying, and the neurosurgeon just stood there. Terry eventually stopped crying and told him she wanted to have it removed. He assented and scheduled the surgery.

On the surface, this aspect of my wife’s medical care seems to be appropriate. She saw the neurologist in a timely manner, who then examined her and appropriately ordered an MRI to evaluate the change that had occurred. When an abnormality was noted, Terry was referred immediately to a neurosurgeon for definitive treatment. So what was wrong?

We, as health care professionals, owe better communication skills to our patients, and the patients deserve to be treated in a better manner.

Neil J. Farber is an internal medicine physician.