Mr. K and I were discussing his recent lumbosacral spine x-ray this week at his follow up visit. Fortunately, his sciatica had improved and the film showed only minor degenerative changes. Mr. K had seen the x-ray report on his online patient portal and was alarmed by the incidental finding of some atherosclerotic build-up in his abdominal aorta. Upon seeing this, he immediately called a cardiologist family friend, who told him, “That’s typical for someone your age (75) — it’s nothing to worry about.”
This didn’t cut it for Mr. K. He explained to me at his follow up visit that he did not find this comment reassuring, because he had a strong family history of coronary artery disease and stroke, and he wanted to know if this finding meant his fate was sealed. He had no history of recent chest pain or neurologic symptoms. Once I understood Mr. K’s real concern, I explained that this x-ray finding was not a great way to gauge his overall risk, but that there were other simple tests that could help address the concern. He was very enthusiastic about having a preventive cardiology evaluation in our office.
As clinicians, we may view certain findings as “nothing to worry about,” but this statement is not always reassuring to hear. I realized that it’s best to tease out the patient’s true concern first, and then decide which type of reassurance is needed.
Hae-Min Jung — the creator of the cartoon above — is an MS2 at the Perelman School of Medicine. He can be reached at [email protected].
Jeffrey H. Millstein, MD, FACP — the author of the clinical vignette above — is the Associate Medical Director for Patient Experience and Lead Physician at Penn Medicine Woodbury Heights. He can be reached at [email protected].
