An elderly man presents with his wife to the practice. They are new in town, having moved in order to be closer to thier daughter. He has significant dementia, is on Namenda, and is extremely well cared for by his wife. She is very bright and says that she can't really see that the Namenda has done much good. He's a delightful man. He smiles, drums on his knees and whistles the entire time he is in the exam room. He doesn't care if you are talking to him or about him. He's kind of funny, and its awkward, but pleasant to be in the room with him and his wife. I ask her how extensive his work up for dementia had been by their previous physician and she's not entirely sure. I ask if it would be okay if I ran a few tests. She agrees.
His B-12 level comes back at 160, which is extremely low. He is not on a vitamin supplement and she does not recall this issue being discussed. It is clearly too late to reverse his dementia, but I advise them to begin monthly B-12 injections along with a mulitivitamin.
Here's the question: is there any value in reporting this finding to their previous physician? She had spoken of him in glowing terms when I first met her and sounds as if he had been caring and gentle with them. Should he be told or "reminded" of the role of Vitamin B-12 deficiency in dementia, or will this information make him feel bad? These are not litiginous people, by the way.
Does a physician have an obligation to let another physician know of a missed diagnosis? A wrong diagnosis?
My experience is that we just pick up and go on and are often "too busy" to share this type of information. Any thoughts?
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment