I'm only in my third year of practice, but already have been humbled several times by middle aged men with a version of the above statement. Often, they only come to see you at the behest of their wife. The ones that concern me are those with seemingly minor complaints, or that brush off symptoms most other people wouldn't.
I recently saw a 60 yo gentleman coming in with a few days of lower abdominal pain. He told me he was otherwise healthy and hadn't been to the doctor in almost 10 years. He had some mild diarrhea but no vomiting, no fevers, no other concerning complaints. He was mildly tender on exam in the LLQ but otherwise stable. I thought he likely had a gastro or mild diverticulitis, and recommended he go to the ER since it was late Friday afternoon and any workup we did from clinic wouldn't return until after the weekend.
He ended up going to the ER the next day, and had some labs that showed a WBC of 13 but otherwise normal. He had an abdo xray that was normal, and was discharged, presumably with the same diagnosis.
Today, he came back to clinic, mostly frustrated that they made him wait and "didn't do anything" at the ER. I reassessed him and was concerned enough to do a more urgent workup. I even phoned the radiologist at the nearest hospital, and she was able to get him in for a CT later this afternoon.
The findings caught me off guard. He has peritoneal carcinomatosis, multiple enlarged intraabdominal lymph nodes, several irregular liver masses, and ascites. Possible cholangiocarcinoma primary.
I was very much surprised by this, and unfortunately I think this came off in my delivery of the bad news to the patient.
I recognize that this is probably going to cloud my judgement and cause me to over order tests for the next while. But I can't help thinking, what if this was my father, who is roughly the same age as the patient I saw today (and hasn't seen a doctor in probably 20 years).
TLDR: 60 yo M that I thought had gastro, actually had advanced malignancy with peritoneal carcinomatosis.
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