Max is listening…
One of those complicated weeks. When listening to what the patient says and interpreting what the patient means is important – these two things however may not be the same…
I’m all ears!
On the patients notes is the name of nearly ever clinican in the building, all have prescribed various treatments for constipation and yet the patient is still constipated. Also within those notes, is very little writing. Alas I like typing note – fearful of getting a complaint.
Alas my collegues don’t!
Next to me is a elderly patient with a long history of unsolvable constipation.
Moments later that patient is laying on the bed. Bowel sounds normal, abdo soft, non specific tenderness. Unable to feel much in the way of descending colon. Percussion light and bouncy – AKA – not constipated.
“Yes, I am sonny!”
Bordering on frustration, Max takes a step back, breathes in and asks a simple question. “What are your symptoms?”
Pt: “I get constipated, I only have rabbit droppings”
I wondered where they’d gone!
Max: “How often do you sit on the toilet and try to pass a motion?”
Pt: “7-8 times a day, but I never pass much”
Max: “…but everytime you go you pass a little?”
Pt: “yes, that’s because I’m constipated”
Max (try not to scream – no you’re not bloody constipated): “Apart from your rabbit droppings, what are your symptoms?”
(Next time someone says they’ve got a BSC – ask if they mean a Bristol Stool Chart!)
Pt: (apparently trying not to get frustrated by my perpetual questioning): “I get bloated”.
Max thinks…looks in the formulary, looks at patients medication. Thinks. Pt is on a PPI for some heartburn experienced several months ago. This was put on repeat, since taking it the patient has had flatulence and abdo pains. This is a side effect of PPI’s.
Max confirms the patient hasn’t had heartburn since taking the tablets, (one month is often enough). Stops the PPI and tries to convince the patient they are not constipated.
I know my patient is not convinced. Fingers crossed. I try to explain that if I tried to poo 7-8 times a day I would only have rabbit droppings. Not convinced – but hopefully the PPI is causing the symptoms, and stopping it will resolve them.
I would love to know if anyone has found this patient clinically constipated, but nobody has written enough in the notes!
Additionally I have a patient whom I referred for counselling, but he didn’t go – thought it wouldn’t help. Keeps coming back to see me and spends 30 minutes telling me his problems, and then says he feels better afterwards. I’m sure the feeling of unburdening his problems, is actually counselling, but not with a trained counsellor. (That’ll be my next course then!) His problems are probably exacerbated by spending 30 minutes talking to me, and then getting the crap beaten out of him in the waiting room by all my patients that have had to wait while he has off loaded!
Hay Hoe again!
The sorting hat says that I belong in Gryffindor!
Said Gryffindor, “We’ll teach all those with brave deeds to their name.”
Students of Gryffindor are typically brave, daring, and chivalrous.
Famous members include Harry, Ron, Hermione, Albus Dumbledore (head of Hogwarts), and Minerva McGonagall (head of Gryffindor).
Take the most scientific Harry Potter
Quiz ever created.