A woman came in with back pain but mentioned a nighttime symptom that made her doctor suspect a heart problem instead. She had severe coronary stenosis and needed a stent. The case shows why fragmented care and ignoring chest pain warnings, especially in women, can be dangerous.
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Many patients don't have an established primary care doctor. They're relying on urgent cares, ERs to function as their primary care doctors. But to be fair to those people that are seeing them as providers, they don't know them. They don't know their history. I have patients that when they walk into my room, I can tell that something is going on with them that they're not even vocalizing to me. I had a patient the other day She came in for back pain, but in talking to her about how her life is going, just general conversation, she started telling me about some weird symptom that she had in the middle of the night just a few days ago. I throw the back pain conversation out the window and I say, we're focusing on your heart. I ask her to go see her cardiologist the next day. I said, let's follow up on the next visit. We'll talk about your back pain then. She follows up on the following visit. Did you go see the cardiologist? Oh, I made an appointment in a few months. No, no, no. I'm calling the cardiologist right now in this exam room, and you're going to see them tomorrow. She goes see the cardiologist. Now, she had a heart attack at the cardiologist. She— during that moment when she was denying her chest pain. What, in your office? Before the 3 days before she came in for back pain, she was writing off her own heart attack. She had severe stenosis in her blood vessels in her heart. She needed stent placed. And now she's advocating for women to to take their chest pain seriously. But you can't know that as an urgent care doctor when you're meeting someone for the first time. It's so true.
