8.5meters of differential diagnosis.
I saw a patient this week (well actually I saw lots of them, but this one in particular caused me more irritation than a fat woman’s thong on a perianal abscess) and I had a student in with me, so consequently I was running late.
This particular patient came in for a prescription for their eczema, no real problem – under control with emollient, ran out of emollient…a real no brainer. Done and dusted….but on leaving the room she said something along the lines of:
“Last time we saw you, you told me I had indigestion, I thought you should know it turned out to be ovarian cancer, but it’s OK I’ve had it treated”.
She left the room and left me stunned…
So I obviously have a rummage through the notes. It turns out that six months ago I saw her with some chest pains, increased burping, worse on laying down, and felt like food was sticking. No weight loss…
“Hmmm”, me thinks, “Sounds like indigestion symptoms. What happened next???”
I prescribed some Omeprazole, gave dietary advice and said to return and see me if there were any problems or if it wasn’t resolving.
TWO MONTHS LATER….she returns to see her Doctor with a small suprapubic abdominal mass, which turns out to be ovarian cancer.
So presumably in the 2 months the Omeprazole had resolved her indigestion symptoms, and yet she has it in her head that thess two events were interlinked. Did she have cancer when she came to see me?…well probably yes, but I’m pretty damn sure she had indigestion and this was nothing to do with the cancer.
So in my 10 minute appointments I’m supposed to ignore the obvious symptoms and management and look for the asymptomatic and not at all obvious problems.
to say something like…
“The indigestion was just indigestion, could you go and tell anyone that you’ve told I misdiagnosed your cancer, that in fact it was a coincidental illness please?”
“There was 7meters of small intestine, and 1.5 meters of large intestine between my correct diagnosis and your other diagnosis. Not to mention that presumably my prescription resolved the problem you presented with, as you didn’t return to the surgery as advised to if the tablets didn’t help!”
OK so I shouldn’t be too harsh. The poor woman has cancer. BUT PLEASE be realistic I can’t give full body MRI scans to everyone with everyday problems incase there is also a nasty tumour growing somewhere.
Robotic Polo’s take revenge on humans for the years of eating their non- robotic children.
OK I feel better now…
I think I deserve a holiday…so check out the blog roll for a read next week, and I’ll come back all refreshed.