Trust but verify

Trust but verify (Doveryai no Proveryai) is a Russian proverb that underlies an important principle in medicine. We need to trust our patients, our tests and our knowledge - but must also always remember to check and verify.

Wayne and I talked about his increasingly problematic hip pain every year. He worked ‘in the trades’ as they say here in Maine, mostly roofing and drywall, but some painting and general construction,  and the stiffness and pain had grown from an aggravation to an impediment and he was beginning to worry about being unable to work.

Four years earlier we had gotten hip films which had been reported as unremarkable other than “equivocal changes consistent with osteoarthritis.’ Over multiple subsequent visits we had talked about repeating the films, but he was self-employed and self-insured, and the high deductible meant he would be paying the full cost. Each time I offered repeat films, he asked what difference repeat films would make, and each time I replied they would help us monitor the progress of his arthritis, which would ultimate result in hip replacement. Only when it had gotten so bad he was facing being unable to work and hip replacement seemed like something he would consider did he agree to repeat films.

The repeat films  showed “The early osteonecrosis seen on his previous study has evolved into full dissolution of the hip.” Review of the original films with the radiologist resulted in an addendum stating that the films showed either osteoarthritis or early osteonecrosis and further evaluation was warranted. We had trusted - but not verified - the initial report.

Trust but verify is a good mindset in medicine.


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