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

Sometimes you can't win

I had some interesting patient experiences this week, so I'm going to talk about them but to preserve confidentiality obviously I won't use any actual names and I'm not going to give all details to further ensure the patient is not recognisable (this is also why I never mention what medical school I am at as I do not want people to be able to work out what hospital I have met particular patients at).

On monday in a clinic for a particular progressive chronic disease (again I will not mention what) I met a lovely elderly (ish) couple. The husband was the sufferer of the chronic disease but his prognosis at the moment for that was very good and he had years left before it would become a problem. At the moment he was just attending clinic so that it could be monitored and he could be educated about what choices he had further down the line. This was one of his early clinic appointments so the consultant was suggesting his wife and him attend a group patient education session on his future possible treatments. The great thing about session like this is that they allow the patient to meet other people who are in exactly the same position and so not feel so isolated in their misfortune of getting a chronic conditon. The couple were very positive about the suggestion and so were going to attend the next session. I had really enjoyed meeting this couple and it was nice to see how chronic conditions can be managed positively and effectively. Unfortuanately though when the consultant looked through some recent scans the patient had had (purely to teach me for my education, not because he was expecting to see anything) things did not turn out to be so positive. The scans showed what was very likely to be lung cancer which the consultant pointed out was most likely to be metastatic (spread from somewhere else) as he did not have it just a few months before when he was scanned and now it was pretty big. Metastatic lung cancer is terminal. I felt really bad knowing this before the patient knew and I expect it will be a while before he finds out for sure as they will want to do proper diagnostic tests firsts. I think the consultant also felt bad that he hadn't seen this before the appointment as then he would not have told them they needed to consider the future and sent them for further education. He was trying to do the best for this patient and to help them plan for the future but in doing so he had made the assumption the patient had long enough left for his chronic condition to progress that far. As my title suggests sometimes you cannot win.

The next memorable patient I met was a much happier experience. She was in her mid 90's and body appearance wise was frail but in all other ways was one of the fiestiest most chirpy patients I had met. She turned up with her nails painted and hair dyed a vivid colour and virtually bounced around the clinic room with her energy and happyness - she very much reminded me of the poem that says "when I'm old I shall wear purple" because she had such a mischeivous/rebellious attitude. She was simply awesome. Frankly if I can be as cool as she is (and so sharp and witty still) when I am in my 90's then I will also be very happy! I wish I could share some more specific anecdotes about this patient as she was so awesome but I think if I did so I would make her too recognisable to either her or her neighbour who came to the appointment with her and I don't want to risk that on the ridiculously slim off chance they ever saw this.

On tuesday I had a cardiology clinic. Last time I went to this specific cardiology clinic three weeks ago I completely crashed and burned when I was getting grilled by the consultant. Furthermore it when everything was snowed up so the consultant had loads of time to grill me as many patients were unable to make the clinic. My partner had got the wrong location for the clinic and so I had to face the torrent of cardiac grilling by myself with no one to hide behind... The grilling progressed to the point that I was even mucking up the bits I did know really well and thus making myself look thoroughly stupid. The clinic then ended with the consultant saying (albeit in a very nice way) that I was rusty on my knowledge and I should go away and learn lots and it would be nice if he saw me later on the rotation so he could see if I had progressed...Eeek! So go and try to learn lots I did. I bought and ECG "made easy" book and I'm slowly learning all about the confusion that is 12 lead ECG's and I've been teaching myself about heart murmurs and heart failure. So what did he grill me on today? Well he asked me (and my partner this time) if I knew what Gin was made from, whether we speak italian and what fiction book we were currently reading. On learning that we weren't currently reading any fiction books he was dismayed that it was all work at the moment and told us we should read fiction books because they were the breath of life... DAMMIT! I couldn't agree more that reading is a great hobby and escapism but part of the reason I have not had not had time is because I was trying to know more about heart to avoid getting another embarrassing grilling. As I said, sometimes you can't win!