When Steven Horowitz, MD, began experiencing neck and arm pain, numbness, and tingling following a bike ride several years ago, he immediately sought care at an elite medical center in California. As he recalls, an incompetent clinical exam and no access to highly abnormal test results done in the ED almost cost him his health. Had he listened to the doctors at that facility, he believes he would have become quadriplegic.
Dr. Steven Horowitz
His training as a neurologist likely saved his life: “I was able to recover because, after arriving home, I reviewed my blood work and MRI online and recognized multiple problems.” He was able to get excellent care at his own local health care facility in Maine. The staff and leadership at the hospital in California wouldn’t admit wrongdoing, and efforts to seek recourse have proved fruitless, he said.
A lingering question nags at him: What if he had been an ordinary patient without medical expertise? What do his experiences say about the health care system’s management of medical omissions and errors?
Dr. Horowitz, 78 years old and retired, continues to teach medical students as an adjunct clinical professor of neurology at the Tufts University School of Medicine in Boston. He is also on the teaching faculty of the Maine Medical Center. He was professor and chief of neurology at a major university in the Midwest for many years.
In 2018, he visited his daughter on the West Coast, enjoying a day of biking. The neck pain began 5 or 6 hours after the ride and spread to his arms. “There was also numbness and tingling,” he said.
“I told them I was a neurologist”
The next day the pain got worse. Dr. Horowitz went to the ED of a nearby medical center with his daughter and immediately disclosed that he was a neurologist. “I did this for several reasons,” he explained. He wanted to alert staff that he had a cervical spine problem because “I wanted them to do a cervical MRI scan, and I wanted to read it because I’m capable of doing that.” He also related a past history of infection and antibiotic use and asked for C-reactive protein and erythrocyte sedimentation rate tests in addition to regular blood work. “Those inflammatory markers, if abnormal, would indicate an infection,” said Dr. Horowitz.
No reflex hammer or Babinski test
During the reflex exam with a spine consultant, Dr. Horowitz noticed that the consultant wasn’t using a reflex hammer, the clinical equivalent of evaluating the heart or lungs without a stethoscope. “I asked where the reflex hammer was, and he said he didn’t need one or own one. He used the inside of his hand. Apparently, there was some mild weakness in some muscle groups, but he didn’t address that,” said Dr. Horowitz. The consultant also didn’t test for the Babinski sign until reminded of it.
He took out a stethoscope and struck the middle of the soles of Dr. Horowitz’s feet. “I thought to myself, this consultant is the consultant for the spine service? How is it possible that he has a stethoscope and not a reflex hammer and didn’t know how to test for the Babinski sign?” The consultant also didn’t examine for gait, coordination, or hand dexterity. “He took his finger and touched my feet and legs. That was his sensory exam. He didn’t use a pin or a tuning fork” or other methods including touch, temperature, position sense, and vibration to assess sensory abnormalities that might signal spinal cord dysfunction.
An MRI at the hospital revealed a mass at the back of the neck. No contrast material was used during the MRI even though this step would have signaled the presence of infection. “Gadolinium should have been injected during the MRI because that would have strongly suggested that this mass in my neck was not a little blood clot and more likely an infection. They would have realized something more complicated than degenerative arthritis was going on. They told me that I had advanced spondylosis and that the mass was a hematoma. They told me not to worry about the blood results. Then they discharged me.”