Tuesday, 20 March 2012

Physician don't heal thyself

Physician don't heal thyself

As well as having hospital rotations this year, I also have 8 morning GP practice visits.  A couple of months back one of my visits was postponed a week before it was due to happen because the GP was ill which I remember thinking was quite worrying because to be able to give a weeks notice of illness the GP was clearly suffering from more than just a mild infection.

When I did have my visit with him I wasn't going to ask what had been wrong with him but he quite happily told me what had happened of his own accord and it was a good warning story about the dangers of self diagnosing when you are a medical professional...

Basically he had been having a very stressful few weeks and had been feeling quite tired and rundown and noticing periods where his heart skipped beats but as he didn't really have time to get checked out he just ignored these until one day at work when he got angina like pains.  So not feeling he had time to get to his own GP surgery (and fortunately doctors cannot prescribe medication for themselves) he asked his gp to fax him over a prescription for GTN spray (the reliever of angina) and said he would get to the surgery for an appointment later in the week.  His GP quite rightly refused to do so unless the GP came in immediately for an ECG.  So the GP moodily agreed to do this but was annoyed at having to when he was so busy.  A good thing he did tho......

On having the ECG it was discovered that the gps chest pain was not due to the traditional cause of angina (the hearts own arteries getting "furred" up with fat gradually over the years causing a narrowing artery and so reduced amount of blood being able to get through causing the hearts muscle to not always get enough oxygen especially at times when the hearts muscle is having to work harder eg when the patient is stressed or exercising) but because he had such severe bradycardia (slowing of the heart) that his heart was simply beating too slowly for enough oxygen to reach the hearts muscle for it to undertake even this reduced level of work.  He was having up to 7 second gaps between beats. GTN spray works on angina by dilating the constricted arteries to an extent, as this was not the priniciple cause of the GPs pain it was unlikely to relieve his symptoms and bits of his heart muscle will have started to die off (not to mention the fact that other vital organs such as the brain will also have been depleted of oxygen).   So thanks to the GPs own GP refusing to be persuaded to prescribe without seeing him, the GP was rushed in to have an emergency pacemaker fitted, something which actually would fix his heart problem, and now he admits he feels better and has more energy than he has for years.

Whilst doctors undoubtably have the knowledge to technically diagnose and treat themselves, when it comes to their own symptoms they can be blinded and biased by their own beliefs about themselves and health agendas.  Self diagnosis...not a good idea!

Interestingly I've noticed that when it comes to adult doctors they are likely to be quite dismissive of potentially serious symptoms whereas medical students are the complete opposite (at least based on my housemates, close friends and self) and even a simple  2 second itch is proclaimed to be pruritus secondary to kidney failure.  Honestly we've all probably used our stethoscopes more times to listen to our lungs  when we have a cold than to actually examine patients!  Sometimes we do get it right tho..or at least describe our symptoms in such a correct way that persuades the doctor we are right or leads them to treat us accordingly just to shut us up!

  I wonder when the hypochondria wears off and the apathy sets in ?  

Halfadoc x

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