Sunday, December 20, 2015

Do you have a myopic view?



When you come to a conclusion or when you just think about something or when you assess people, do you take the time to really look beyond what you see or do you, like most people, assume you know and rush to judgment? Do you lack insight, discernment, or perception?

The dictionary defines myopic as lacking discernment and understanding, short-sighted or not insightful, inability to act prudently, inability to see distant objects clearly, lacking foresight........in other words, you can't see the forest for the trees. You are in need of some serious bi-focals.

The problem with a myopic view is that it can impede your intelligence, discernment and just overall understanding of a problem, a situation, and your out-look on the world and the people in it. A myopic view can stunt your growth by keeping you stuck in stereo-types, cliches, bias or clicks. It can also keep you from generating new ideas that are fresh and inspiring and can even impede your problem solving skills.

When I was looking after my dad for about 6 years before he died, I saw him deteriorate. I knew he was getting worse. One day I came up to his place to check on him and I saw quite a bit of edema in his left leg. Now he had a BTK (below the knee amputee) on his right leg (due to diabetes) so it was only his left left that was present with major swelling. Due to my experience and several years in the medical field, I knew immediately when I pressed down on his swollen leg and saw pitting edema that he had congestive heart failure. Peripheral pitting edema is generally manifest due to renal insufficiency. And this is indicative of CHF.  I also observed that he had cellulitis (inflammation/bacterial invasion of the skin) which manifests as fluid leaking out of the subcutaneous layers of the skin. Because his kidneys were not functioning properly due to the heart not pumping enough blood to metabolize them, his problems were only apparent as his heart gets worse. He frequently complained of PVCs (preventricular contractions) and he felt he had COPD which is frequently confused with dyspnea and orthopnea, a increase in venous return to the heart that leads to an increase in pulmonary congestion because of the inability of the compromised left ventricle to accept and to pump the increased load. If you don't have a myopic view, you can see beyond the immediate of outward externals because much of what happens internally in our bodies tends to manifest on the skin or outward symptoms. Now my father was a M.D. and I still have his diplomas in my office hanging on the wall but when I told him, "dad, you have congestive heart failure", he said to me, "no I don't".  I repeated myself, "yes you do." I then proceeded to open one of his medical textbooks to the chapter on Heart Failure. I said, "dad read this" and pointed my finger onto the page as he was still saying no.

When I brought him into the ER, another man who was an M.D. just looked at him, didn't ask any questions about his symptoms or how he was feeling and stated succinctly, "osteomyelitis." I then said to the doctor, "actually doctor I was thinking Congestive Heart Failure because of this pitting edema". I pressed down on my fathers leg that left a thumb imprint to show the doctor. Now this doctor clearly had a myopic view. First off, he never asked my dad any questions.......he just rushed to a conclusion/diagnosis and if this doctor understood anything about clinical presentations, he would have concluded that his diagnosis of osteomyelitis, a serious bone-infection, would have been incorrect. A clinical presentation assesses the physical symptoms that are clearly present and then asks questions to come to a logical conclusion. Since osteomyelitis is a serious bone-infection, any medical provider with adequate training would have know right away that the patient would have presented themselves with fever and chills, none of which my dad had. When I said this to my dad, he said, "you're always telling the doctors what to do." But I knew I was right about this because I could see deeper beyond what was physically present. It's called discernment and insight which frankly I think so many people lack. This is why so many of us rush to judgment or assume to quickly.

As the PA brought in a EKG, she said to me, "his p-waves are normal" but I insisted that it didn't matter because he needed an advanced study with an echocardiogram to confirm the diagnosis. The M.D. in the ER ordered a bone-scan but I said it would be unnecessary. After he was admitted they went ahead and performed an ECG on his heart and it was confirmed that he had CHF. There are different types but his was a non-ischemic cardiomyopathy. Ischemia meaning blockage which in his case he did not have. He just had a very weak, diseased heart that had lost its pumping ability because his stroke volume was only 20%. It wasn't until another male colleague, the cardiologist who visited him in his room to confirm the diagnosis, did my dad believe me or consider me credible. How unfortunate.

I could bring up many more instances when this happened but the point is that having a myopic view can potentially be dangerous at worse and stunt your intelligence at best. So just remember this the next time you judge a situation or person........don't let a myopic view cloud the truth.