Why So Many Visits for a Simple Condition?
Case #1 - A Diagnostic Odyssey
Case #1 - Urinary Tract Symptoms in a Young Woman
A 24-year-old woman, whom I recently met at the Free Clinic, presented with recurrent urinary burning. Her symptoms began 11 months ago after visiting her regular healthcare provider, where she was diagnosed with a urinary tract infection and treated with antibiotics, which temporarily relieved her symptoms. However, over the subsequent months, she experienced several more episodes of urinary discomfort, including frequent urination, nocturia (urinating at night), occasional microscopic hematuria (blood in the urine), and intermittent mild abdominal pain. After seeing multiple providers in different clinical settings, undergoing multiple urinalyses, a CAT scan ($4500), and an abdominal ultrasound ($500), all yielding unremarkable results, her symptoms reoccurred. She was then referred to a Gynecologist, who conducted a comprehensive evaluation for sexually transmitted infections and recommended no treatment for a benign vaginal cyst. Subsequently, she was referred her to a Urologist. The Urologist performed a cystoscopy ($1300), which also revealed no abnormalities.
Due to a change in employment and pending activation of her new insurance, she sought care at the Free Clinic during another episode of urinary discomfort. Before each examination, I use an adaptive computer patient interview to gather clinical information instead having the patient fill out questions on a clipboard. The computer interview branches to ask additional questions to abnormal answers, replicating a what a doctor might ask. After reviewing the results of the computerized patient interview for urinary problems, I listened attentively for several minutes as the patient recounted her frustrating journey through the healthcare system without resolution of her problem. I then inquired whether she had noticed any correlation between her urinary symptoms and sexual activity, to which she paused, as if a realization had dawned upon her, confirming the association. Her problem, called “honeymoon cystitis,” is common and easily controlled with an inexpensive generic prescription with vaginal hygiene patient education. She said that no one had previously asked her that question or presented what she could do for herself.
Why did it take so long for her to have a resolution to a simple problem?
How did multiple healthcare providers miss this common condition?
Did the patient do anything to delay her diagnosis?
How could this happen in a modern healthcare system?
Preview
The Episodes in Case #1 will explore key questions as we follow the patient’s journey. In Part I (Episodes 2-10), we’ll break down each step, analyzing what the patient went through and why. In Part II (Episodes 11-15), we’ll present how the patient's experience could have been different. Through these case and other medical missteps, we’ll uncover the root causes and systemic issues leading to suboptimal healthcare outcomes. The Episodes are designed to be read in 5 minutes. Each Episode will focus on a different healthcare concept, with an emphasis on the doctor-patient relationship, offering actionable steps for both doctors and patients to enhance care for patients and bring renewed fulfillment for doctors to practice medicine.
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Action:
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