Section: Letter to the Editor

Letter to the Editors: 1/26/17

To the editors:

I would like to respond to a recent Collegian article (“Our Health Center Misdiagnoses”, Nov. 17, 2016) regarding improper assessments at the Student Health Center and lend a medical perspective. As a Kenyon alumnus and a practicing physician for 15 years including a year covering our Student Health Center, I may have some insight.

My experience has shown that the staff at Student Health has always been proudly dedicated to maintaining campus health and well-being. I doubt that has changed. With over 5,000 patients annually, they don’t take shortcuts. They are on call continuously, frequently speaking with concerned parents and driving people to the ER. However, the principles of medicine are a little more complicated than were reflected in your article.

Unfortunately, diagnostic errors do occur, approximately 5-15 percent of the time depending on the setting. These studies are not used as a crutch or excuse, but as an opportunity for self-assessment and means for continuous improvement. We abhor mistakes. Regardless, making even a simple diagnosis can sometimes be challenging. Patients often exclude critical details or are biased by results of search engines. Every medical malady is undiagnosable until it adequately progresses. Testing done shortly after symptoms begin may yield a false-negative result. Furthermore, when an illness does develop, the presentation is often deceptively atypical.

Distinguishing anecdotes from trends is crucial. In a case of abdominal pain, patients occasionally have overlapping maladies simultaneously. When an explanation for a patient’s nonacute abdomen is uncovered, such as evidence of a UTI, it’s reasonable to treat the patient with antibiotics and monitor for improvement. Before departing, students are told to contact the center if their recovery doesn’t go as expected. This allows providers to diagnose patients efficiently without missing rare, secondary concerns while avoiding unnecessary testing.

Last year, health care spending reached $3.2 trillion. To combat this, health care professionals undergo extensive training, which includes an emphasis on performing thorough physical exams and prescribing cost effective medications. CT scans to evaluate non-acute abdomens carry associated harm, providing the radiation equivalent of 300 X-rays to a student’s midsection.

Note that the Health Center didn’t prescribe antibiotics for a cold, that no patient was reported suffering from an allergic reaction to medication or that antibiotic resistance was a developing issue. Sadly, with a decline in new antibiotic development, that article is just around the corner.

Best regards,

Brad Smith, MD, Medical Director of Knox Urgent Care, Class of ’87


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