Sah S. (2015). Investigations Before Examinations: “This Is How We Practice Medicine Here”.

“All new patients have an x-ray before seeing the doctor.” As a physician, I found this sentence baffling—I had been taught that the physician’s role is to first see a patient, take a detailed history, perform an examination, and consider the differential diagnoses. Only then could I consider the investigations required to get closer to a diagnosis and determine a treatment plan.

As a patient, however, my experience was different. Previously healthy with no medical problems, I began to feel a growing discomfort in my shoulder after a mandated vaccination. As the weeks progressed, the pain worsened, ultimately inhibiting me from performing routine tasks such as getting dressed. My primary care physician suggested steroid injections or a course of oral anti-inflammatories together with corticosteroids. Reluctant to have more injections, I opted for my physician’s suggestion of 1000 mg naproxen sodium daily while cautiously avoiding the oral steroids. As a small 160-cm woman, I am more sensitive than most to medications. In just 2 days, the naproxen gave me excruciating stomach pains—the treatment was worse than the shoulder pain. I berated myself for not questioning the physician about the high dosage. I stopped taking the medication and decided to try physical therapy.

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Also see the related JAMA Internal Medicine Editor’s note: Testing before seeing the patient.

Sah, S. (2015). Investigations before examinations: This is how we practice medicine here. JAMA Internal Medicine, 175(3), 342-343. doi:10.1001/jamainternmed.2014.7549