Misdiagnosed Green Beret Demoted, Nearly Court-Martialed Before Rare Illness Revealed

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[RANGERAIRBORNE]

Very interesting- but medicine is (I have heard) both an art AND a science. And occasionally, patients do show up with rare or very hard-to-diagnose diseases.

My position is that you need to believe in your patients symptoms, until such time as you have convinced yourself (by history, physical exam, lab tests, etc) that the symptoms are not real.

If you disbelieve everyone who comes to you with subtle clues of early disease, you will never diagnose anything until it has advanced to a point where the clerk filling out the insurance forms would recognize it...

[bethelgrad]

"his parents and his wife are struggling to understand how the military could have misdiagnosed Alford's erratic, forgetful behavior"

Doesn't surprise me that they would misdiagnose. Our batalion doctor told me my stomach pain was just indigestion (couldn't eat, vomiting, severe cramps)--36 hours later I was in emergency surgery for a ruptured appendix. If the country wants socialized medicine, they should look at the way its done in the military. Sure its free, but I don't care how much blood you are losing, sir---you will wait in line like everyone else.

I'm sure our field medics/corpsmen are great in battle, but health care in the rear with the gear needs some work.

[LibWhacker]

. . . and done no reasonable work-up . . .

I understand what you're saying, but what's reasonable? Unfortunately, cost must be taken into consideration. Is it reasonable to do perhaps thousands of dollars of testing, chasing diagnoses that are so rare we know, a priori, they are not likely to come back positive?

Doctors, insurance companies, even the Army is under constant pressure to reduce costs. I hate it myself, but it's a necessary balancing act. If it were just this one guy, I'd say spend a million. But it's not just this one guy; it's millions of people with millions of symptoms that don't fit.

[LibWhacker]

. . . but medicine is (I have heard) both an art AND a science . . .

Very true, and as I get older I find myself hoping that the last doctor to treat me is more artist than scientist! Because when I've had problems in the past, it's always been weird symptoms to some common malady. So, my scientific type docs miss it, lol! Almost causing my demise in one case. :-(

[RANGERAIRBORNE]

I know I sound like a broken record on this (remember records? They were these sort of flat plastic things you got music on- but that's not important right now...)

Once again, my argument has been misinterpreted- I'm staring to wonder if my communications skills are completely shot- maybe I have CJD!

nyway, I certainly don't advocate doing every test known to man on everyone who walks into an ER with a headache. Just a basic history and physical is quite enough for the vast majority.

But those minimum things need to be done PRIOR to labeling the patient as a loser, a liar, a crock, or (you fill in the blank).

Am I being unreasonable? I mean, I'm fairly familiar with military medical care, at least, and I know for a fact that there has always been a tendency to label "difficult" patients as simple malingerers- especially at the Troop Clinic level, where the folks are overworked and do not have lots of time to do extensive work-ups.

To be fair, there are a lot of real malingerers out there- especially when it comes time to go to the field, or do some tough job in the motor pool, or go on guard duty at 30F below zero.

But that doesn't relieve medical providers from the responsibility of taking each complaint seriously until there is actual evidence, one way or the other (doesn't have to be a colonoscopy and an MRI on everyone, either!)

[RANGERAIRBORNE]

I xcould tell lots of horror stories, but I'll settle for only two. I had a soldier who was being discharged for gaining weight, and "refusing" to lose it. He had been seen on multiple occasions by the "Docs", and given diet advice (no work-up). Just prior to discharge, an observant medic noticed fairly obvious signs of thyroid disease. This was treated, and the weight gain was reversed.

In another case, a soldier was cited for "sleeping on sick call", and told to return to his Company for disciplinary action. A 91C intervened, did a quick history and got some vital signs- it turned out that the soldier had bacterial meningitis. Yes, it took additional studies to make the specific diagnosis, but it was the 91C taking the complaint SERIOUSLY that allowed the necessary work-up to be done.

[PeyersPatches]

My brother, a career officer, was also misdiagnosed by Army doctors and forced to retire. He went through hell with the doctors......

---

I had an ovarian cyst burst while in the USMC and the foreign doctor kept telling me that I simply had (as she pronounced it): "Men-stul Cwamps". Thank God I worked in the CG building for a full-bird who knew me well. He made one call and I was off to the Naval hospital. I know of worse stories - a SSgt with misdiagnosed diabetes (they told him he had AIDS) etc......I will NEVER allow a military "doctor" to tend my family. My apologies to the good ones out there (although they sure are hard to find).

I only know about this story from the post; however, it seems to me that when an oustanding SF soldier suddently goes from "hero" to "zero" in his behavior, THAT alone should have told people around him that something was amiss and the first area they should have looked was organic brain dysfunction. God bless this dear man, he deserved better.

[RANGERAIRBORNE]

</i> Don't know HOW that italic tag got in there- probably need to slow to my regular typing speed of approximately 10 WPM...

[PeyersPatches]

I agree w/you. Well said.

[RANGERAIRBORNE]

Thank you! I had despaired of being understood on this, let alone agreed with!

DE OPPRESSO LIBER

[TrueBeliever9]

I only know about this story from the post; however, it seems to me that when an oustanding SF soldier suddently goes from "hero" to "zero" in his behavior, THAT alone should have told people around him that something was amiss and the first area they should have looked was organic brain dysfunction. God bless this dear man, he deserved better.

That is SO RIGHT!

[Polybius]

Hmmm- you or I COULD have the early stage of some hard-to-diagnose disease. Let's say that I had a new onset of severe headache, with visual problems associated with it.

Well, those are not subtle, non-specific symtoms. Those are pretty obvious.

Let's say that your Division Officer is complaing that you are "acting strangely" and are doing a piss poor job. However, all medical tests are negative.

What I would NOT accept would be to be branded as a hypochondriac, or a drugseeker.......

You are absolutely correct.

"Hypochodriac" is not a medical diagnosis. It is a personal judgement and the wise physician should never have that word in his medical vocabulary.

The wise physician is not only aware of the things he "knows". He is also very aware that there are a countless number of things he has no hope of ever knowing.

The post you referenced was a reply to another post that claimed that it was the doctor's job to "know" if a disease was present. As I pointed out, only God has such absolute knowledge.

However, in such a case, if all tests are negative, the diagnosis is that no diagnosis could be found. Period.

As an example, let's go back to a certain sailor that I once had as a "Frequent Flyer" to Sick Call. This particular individual had a long history of alcohol related offeses, Captain's Masts, a previous drug offense and an all-around reputation in Deck Division as a "malingering dirtbag".

His Division Officer and the XO would regularly complain to me that he was using Sick Call as a means of getting a morning off once a week. I would reply, "Even 'dirtbags' can get sick too".

One morning our Frequent Flyer presented with a brand new complaint. Calf pain. The X-Rays showed an osteosarcoma: a bone cancer.

When I told the XO that I had medically transferred this guy off the ship, the XO gave me that "Sh#t Doc, did you just fall off the turnip truck" look and asked me when he would be back to duty.

I replied, "Never". He would lose his leg and had a good chance of losing his life.

A few months later, another Division Officer was complaining to the XO that one of his "malingering dirtbags" was using my Sick Call as a means of getting out of work.

The XO replied to the Division Officer, "Well, as Doc once taught me, even 'dirtbags' can get sick too."

[neverdem]

"But that doesn't relieve medical providers from the responsibility of taking each complaint seriously until there is actual evidence, one way or the other (doesn't have to be a colonoscopy and an MRI on everyone, either!)"

I think you nailed it right there. The soldier didn't have the complaint. In fact, to the extent that he was aware of it, he was in denial, to use that hackneyed phrase, as described by the doc seeing him go to the window and counting floors. His superiors had the complaint.

You didn't lose your ability to communicate. I forgot to address the latter point you made in comment# 40 in which I agree. His initial diagnosis of malingering stuck with him like glue.

[RANGERAIRBORNE]

OK, we agree on this. I think the only thing we might debate is just how far you must go to prove or disprove the existence of a treatable disease (NOT the existence of symptoms- being subjective, they can never be disproved).

I don't know that I would have been too happy to have a team member off on sick call 2 or 3 times a week- assuming that a reasonable history and exam had been done, appropriate to the complaint.

What is "reasonable" at a Battalion Aid Station or a Troop Clinic may well be regarded as utter malpractice at the Mayo Clinic. So there is lots of room for differences of opinion.

[PeyersPatches]

Enlisted get the worst treatment medically; officers do not get a whole lot better in many cases. Now, had this fellow been a member of Congress and merely passed wind (ok more so than Congress usually does), every available test known to modern science would have been performed from his head to his toes - from the best docs and best hospitals - all at taxpayer expense.

OK I should stop now because this all gets my blood pressure up! Ack!

[AndyJackson]

The soldier's father said the deputy commander apologized for what the family had been through, assigned a lawyer to work with them on pay and benefits issues and said he would personally handle any future problems.

This is how men behave. Not butt-covering or denial. Just honesty and a responsible adult to see that problem is sorted out. Nothing more and nothing less.

[AndyJackson]

The soldier's father said the deputy commander apologized for what the family had been through, assigned a lawyer to work with them on pay and benefits issues and said he would personally handle any future problems.

This is how men behave. Not butt-covering or denial. Just honesty and a responsible adult to see that problem is sorted out. Nothing more and nothing less.

[txzman]

"Sad as this situation is, they can't blame the military."

Actually he cannot sue the military, but he SURE AS HELL can BLAME them. I went through the military medical system for three years with undiagnosed disease that almost killed me and saw more than 20 physicians - all whose attitude was "you must not want to go to school today". Until I started bleeding internally that is.

This man was killed by bad medicine, in my judgement - I have been in healthcare for 25 years and watched the military's system in action first hand. Except for the key centers, you need to trust another doctor if they can't figure things out.

[LibWhacker]

But that doesn't relieve medical providers from the responsibility of taking each complaint seriously until there is actual evidence, one way or the other . . .

Your communications skills are excellent. And you're not being unreasonable by any means. In fact, I'm trying very hard to make as much sense as you're making! :-)

Without knowing more about what was actually said by his Army doctors, my take so far is that they did a reasonably professional job and didn't dismiss his complaints or label him as a malingerer. The only doctor who actually said anything like that was the psychiatrist who said Sgt. Alford was faking it, not unreasonable in my eyes, given the evidence he and the other doctors had in hand. The doctor in Kuwait only said that he found no evidence of disease. But I'm under no illusions; Army doctors can be almost as cynical and tough on soldiers as First Sergeants. It's just a real sad situation all around. I'm glad his dad lied to him.