Twice this week I saw patients who I hadn't seen in ages whom I last saw for random problems. I had previously made their diagnosis, prescribed a treatment, and said, this should work, let me know if it doesn't.

It didn't, but I didn't know, and then they never went back to me to address this.

I have no idea why this is so common. I am not an infallible god and medicine is an art. Sometimes stuff just doesn't work as planned. If I told you to do X about Y, you did X, and then Y is not better, you need to tell me.

I care for literally thousands of people and between portal/online/in person and tell 40 different people a day to do different stuff to fix their issue. If I don't hear anything, I assume no news is good news.

I cannot speak on behalf of other physicians, but if I told you to do something, it failed, and you come back and tell me it failed, I'm not just going to throw my hands up and say, "sorry! I dunno!".

I have never in my entire career stopped trying to figure someone's diagnosis out or stopped trying to get them in with the correct specialist/test/surgery that could fix their thing as long as they remained an active participant in their care.

The patient yesterday told me they did the thing, it didn't work out, so they just learned to live with it as they, "didn't want to bother me about it".

I WANT TO BE BOTHERED. This job is really the only thing that gives my life any meaning. Its like getting to play Professor Layton games all day in real life, except the topic is medicine, and the reward is a dopamine donut every time I sink a 3 pointer. I am literally thrilled to continue to work with someone on figuring out their rare diagnosis. I've gotten to the point of using whole genomic sequences to figure out the exact thing happening to someone more than a handful of times.

In short, please allow me to fail and try again. I am eager to do so. I can't speak for your own personal doctor, but generally speaking, doctors do not want their patients to remain sick. I can't sleep at night sometimes as I'm being driven insane by a lack of an explanation for someone's weird problem.

I once woke up in bed on a Sunday morning to a completed diagnosis. I had worked this lady up for weeks who had seen everyone under the sun for her belly pain. She had been labeled "anorexic" as she didn't want to eat, as eating = pain. I was absolutely certain this was MALS or SMA syndrome as I could hear the bruit on exam and figured that a bunch of GI docs just didn't bother to use their stethoscope properly. I ordered the angiogram to cinch the diagnosis, and... it came back negative. I was crushed to tell her that my theory about her diagnosis was off, but asked her to give me time to think more on it.

I woke up that weekend on Sunday morning, sat up in bed, and went "oh shit, we do CT angiograms with people lying on their back, and so gravity would disrupt the study as she gets the pain while seated/standing. The crux of her diaphragm only pinched off her celiac artery when the weight of her thoracic organs sat on it. One custom ultrasound study later and the diagnosis was done and she was off to surgery. I won outstanding case of the year for it in 2016 in Michigan. She is one of many times that I was just like doing a thing, and then BANG, the solution came out of nowhere like some subconscious subroutine process that was like, "File's done".

In short, I am a medicine obsessed lunatic who spends his day thinking about your weird thing. If attempt #1 isn't a success, please reach back out. I will keep trying until one of us dies.

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