When We Fail
We each have a patient’s story that burns a hole into our memories and compels us to revisit the story again and again. For me that story is about Sean, a 38-year-old former Division I college football player who I met while he was lying in bed, dying of heart failure.As the rheumatology fellow on call, I was asked to see Sean to evaluate for an underlying autoimmune disease that could be linked to his cardiomyopathy. Five years earlier, when he noted unusual salt-and-pepper type changes of the skin on his chest, back, and forehead, he was told this was vitiligo. That presumed diagnosis entered into his medical record and, ever since then, was passed on as established fact. What it really had become was chart lore—a misinterpretation of reality that, through the copy-forward function of the electronic medical record, had been solidified into “the truth.” This explains why, when admitted earlier in the year with severe shortness of breath, the echocardiogram showing an ejection fraction