Archive for May, 2008
Demented!
It’s that time of the year when I start to review patient with dementia and very topical it is too at the moment. As the Kings Fund has released a new report on the short fall in mental health spending and the increased amount of patients with dementia. It states the number of people with dementia will go up from 582,827 in 2006 to 937,636 by 2026.
My first thought is selfish…how old will I be in 2026…
I want to know for two reasons….Firstly : will I still be working….answer yes, and lots more year before retirement. (Heck that’s a lot of dementia review I’ll have to do…it could drive me mad(!!!)
Secondly : will I be starting to get the early signs of dementia (and would anybody notice). I’ve had the dementia leaflets in my room for over a year, I keep meaning to put them in the waiting room but keep forgetting…is it starting already?
The BBC have published a handy guide on when to seek help, and reports that “The Alzheimer’s Society said up to two-thirds of people in England with dementia are never diagnosed, as they do not recognise the symptoms”. So let us take a look….
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A problem downstairs…
Last week was one of those where all my patients seemed to have a need to drop their trousers, hitch up their skirts and generally reveal themselves in ways they rarely would, even after a night in the pub.
As I said only last week history taking is a vital part of clinical assessment, but when it comes to problems “down below!” history taking can be a bit challenging.
Steven Seagal Movie about dysuria?
Patients seem to adopt one of two approaches when they have a problem below the belt, both of which are a little too extreme to be helpful (or pleasant).
The first extreme is the patients (mostly men), who have sat in the waiting room worrying about exposing themselves, and not thought about what they are going to say. These patients think being called to the consulting room means they can start undressing on their way down the corridor. So before I can say “‘mornin'” I’ve got genitalia facing me and patient demands:
“Look at this, do I need to get a divorce?”
The other extreme is the patient who has been practicing exactly what to say (for approximately 4 weeks) and when it comes to examination they say “OK” and then stay exactly where they are. Prompting encouragement to actually stand up and “drop ’em” and “No, I’m not going to undo your flies for you, your hands were working before the consultation, I’m sure they are still able”.
Also history taking is only any good, when accompanied by a vague idea of what the hell the patient is talking about…
Key: Pt v’s Max
“I’ve a problem downstairs” – “You have rats in your cellar?”
I’ve got sore “bits” – “I’ve heard of drill bits, but never saw bits”
“I’ve got a personal problem!” – “As oppose to a impersonal problem?”
“My cock sore!” – “What did your cock see? Chickens??”
“My cocks got a rash” – “Take it to the vet, I don’t do poultry care”
“I’ve a problem with my toilet” – “Call a plumber!”
“I’ve a problem with my crack” – “See your drug dealer, but I doubt you’ll get a refund.”
“I’ve a problem with my plums” – “Tell the greengrocer about it!”
“I’ve got a problem with my wee’s” – “Do you use an inhaler?”
and thus it goes on.
One parting comment….whatever happened to sexual health, condom use and just good old fashioned common sense? When I was growing up (debatable whether I actually have grown up or ever will), everybody was hyper-paranoid about AIDS. Now it rarely gets mentioned in the common media, but statistics show it is ever rising.
Brings a whole new meaning to the term sexual aids! Sorry that’s a bit of a heavy image to end with, try this French Campaign…
Little Miss Muffet sat on her what???
Well you know what they say about Scorpios in bed…
Well, I’m not here next week, so in the meantime perhaps you should check out a newbies that came to my attention…..so take a peak into the world of : Circus Nurse. Enjoy.
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Lessons in History…
Taking a history from a patient is a challenge, sometimes the patient will give one word answers and sometimes it’s difficult to get the patient to stop talking. None-the-less a good and comprehensive history is essentially….
IsHere is an example of why….
Little girl tells mummy she put a bead up her nose. Mummy looks and can’t find it, they rush to the hospital. Wait for a few hours and then the Doctor hears the story of a little girl who put the bead up her nose. He too can’t see anything…
Now perhaps I’m a bit of a tough nut, had this been my patient (or child), I would have gone down the “well as long as your chest is fine, I don’t think we need to worry too much, you’ll snort it back, swallow it and poo it out”
But I’m talking about the super keen shiny new registrar, who decided an Xray was necessary. Exposed the young girl to some radiation and guess what….Nothing showed up.
Now the lesson here is simple…..if a child tells you they’ve put something up their nose, take a history detailed enough to find out if she then took it out again. With tears in here eyes the little sweetie said…
“Everybody asked if I’d put it up and I did, but nobody asked if I’d got it down again!”…
(Rich sarcastic tone….)Oh, how her mummy laughed….having spent a quality 5 hrs hanging around the hospital….
The second lesson this week is in cheek biting. Essential behaviour to stop you laughing in your patients face when they come up with a corker.
My example this week was a lady who had felt achy and unwell and told me her “nymphs were up”.
Hylas has tonsillitis and his nymph loads where up again….
Hmmm, assume she meant Lymph’s….AKA Lymph Nodes.
I was of course a true professional, and doubt she even noticed the little grin that kept trying to sneak across my face….ho hum.
It shouldn't happen in health care 