Max interrogates
Well we have already established that Max is listen, and indeed this is an important clinical skill, however sometimes listening is not enough. Understanding is important, and to understand asking probing questions is sometimes necessary.
Today I have been interrogating my patients, and it’s a good job I have been too!
Case one:
Breezy “Hi! I’ve just come for my depo injection“
Normally the Practice Nurses do this, but short on appointments I occasionally get the pleasure of stabbing young women in the buttocks, (obviously avoiding comments like - “Just a little prick in your bum to stop you getting pregnant”
Max: How long have you been using Depo?
Breezy: Oh a fair while!
Max turns on the spot light, shines it in the patients face and interrogation begins. Turns out the patient has been using it for 12+ years. This is not ideal as it can lead to increased risks of osteoporosis.
So we get to the nitty gritty, she is not happy at the prospect of a change, but comes to terms with the fact that it might be worth trying another method. For the last 12+ years, she has come in, had a jab and gone. All happy and easy, but not today…Max is looking for a fight….
Case Two: “Wants repeat Px” comes in. Using Citalopram for depression for several months, with good effect. Probably not ready to come off just yet.
W.R Px: I get occasional headaches with them, could it be because I drink with them sometimes?
Max (Turning on the spot light again): Well you shouldn’t drink with them really. How much do you have?
W.R Px: Oh, not much.
Max sits quietly and waits. W.R Px squirms slightly and realises question hasn’t been answered yet.
W.R Px: Some occasional vodka.
Max remains quiet. Pt states about 2inches out of the 1litre bottle a night, possibly more.
Max speaks: How often do you buy a bottle?
Turns out 1-3 litre bottles weekly (Occasional drinker?!?)
Max: “Hello, could I make a referral please?”
Before the morning was over I’d also diagnosed anxiety attacks, in a woman who blatantly denied anxiety, but whose husband agreed with me, and so I ended up running 30 minutes late due to some unpresidented marriage guidence, but that’s another story…
This was just one mornings clinic. The afternoon was worse, as I’ve stated before - sometimes you just have days where everybody has complicated issues. I may not be the sweetest person to see in the surgery, but I’m not afraid to ask the questions other don’t like to, more about this next time…
Meanwhile…Change of Shift is out, care of Someday Nurse…enjoy
I once treated a “Nan down” who’d collaspsed ? cause . She told me she was healthy.. when I asked about meds I found out she had a hiatius hernia, high blood pressure, a cardiac condition she didn’t but it was to do with it having “a dodgy tune”, she was on antibiotics for a leg ulcer and last saw her GP a week earlier as she was having trouble sleeping…
I’m similar to you in that I wont hesitate to ask the question, especially as your answer may save your life…. (and me a messy court hearing!)
Medical Guy
September 20, 2007