Why 'everything's fine' should worry doctors

NPR essay details troublesome incident with a patient

After falling for decades, the death rate for middle-aged whites began to increase in 1999.
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Dr. John Henning Schumann initially believed an elderly patient who would tell him he was doing fine during his regular visits.


Yet Schumann admits to missing some clues that may have led to an earlier Alzheimer's diagnosis with the man in an article he penned for NPR Health

The doctor says the man was a regular patient for four years, coming in for check ups on his Type 2 diabetes and high cholesterol, which were regulated with medications. The patient then started bringing in a note from his wife to remind him to ask about knee pain he was having, something Schumann found odd, but didn't trigger the doctor's "sixth sense" to truly investigate.

Eventually, the patient experienced internal bleeding from his gastrointestinal tract which led to severe delirium, several hospitalizations and a slow recovery. His wife told him later that he had been diagnosed with Alzheimer's which made Schumann guilty. Here's why:

The truth is, I hadn't wanted to look. The red flags had been there: stereotypical visits with nary a complaint, little regard for current events and limited memory of our previous encounters.

In retrospect, I realize that my patient was adroit at masking his dementia. He was still capable of small talk. Since I didn't probe very hard, I wasn't going to find out the degree of memory loss that he'd already suffered.

Schumann than notes that an earlier diagnosis could have helped prevent some of the problems the patient and his family went through, and cautions both himself and other doctor's with accepting "everything's fine" from patients when even small signs of a bigger problem are present.

Along with contributing to NPR Health, Schumann is also currently Interim President of the University of Oklahoma and host of Public Radio Tulsa's "Medical Matters" show.