The change in his face was almost surgical in its stages. First the smile vanished. Then confusion. Then recognition, as my name and title landed. Then something very close to fear. Color drained out of him. “Chief of surgery,” he said, almost under his breath. “I didn’t realize he was your son.”
I took a step closer. “You didn’t realize, or you didn’t care until you heard my title?”
He blinked. “He said his name was Ethan Mills. I didn’t connect—”
“That ‘Mills’ is a common surname? Or that it shouldn’t matter?” My voice stayed quiet, which was more effective than yelling would have been. “You are a physician. Your obligation is to assess and treat patients based on symptoms and findings, not appearance. My son presented with right lower quadrant abdominal pain, nausea, vomiting, and fever. That is appendicitis until proven otherwise. Instead of ordering labs, imaging, and a proper abdominal exam, you labeled him a drug seeker and prescribed Tylenol. Do you understand what you’ve done?”
He tried to gather himself, squaring his shoulders in that way mediocre men do when they want to borrow authority from posture. “Mr. Mills presented with vague complaints and a history inconsistent with serious pathology. His pain level seemed exaggerated, and he specifically asked for narcotic pain medication, which is a red flag for drug-seeking behavior.”
“Did he ask for narcotics,” I said, “or did he ask for pain relief after sitting in your emergency room for hours in agony?”
Vance’s jaw tightened.
“Did you run labs?” I asked. “Did you order a CT scan? Did you document a proper differential diagnosis? Did you perform a complete abdominal examination with assessment for rebound tenderness, guarding, rigidity, or peritoneal signs? Or did you take one look at a young man with tattoos and decide he was a junkie?”
He crossed his arms. “I used my clinical judgment based on fifteen years of experience. Not every patient with abdominal pain needs extensive imaging. Hospitals don’t survive by ordering CTs for everyone who claims they’re in pain.”
“Clinical judgment requires clinical assessment,” I said. “Show me his chart.”