Just last week, we received a request from a GP for
urinary porphyrins, the clinical details being the
patient is convinced that he has porphyria cutanea
tarda having read an article in the internet about
skin photosensitivity and blistering. And guess what?
he did have greatly elevated porphyrin level c/w
PCT!!We know that well informed patients can influence
their course of investigation and management as this
case illustrates. I can only guess that such cases are
going to be on the increase, whatever you decide about
who should access this mailbase as sources of health
information on the internet are vastly expanding.

regards.


--- Dr D G Williams <[log in to unmask]> wrote: > I am
getting quite a few grumbles from my GP
> colleagues about patients who come 
> to the Health Centre armed with reams of data about
> this and that garnered from 
> the Internet. One in particular marched in to see
> his GP, told him what his 
> diagnosis should be and said that only one drug (I
> forget which one) was 
> necessary for treatment.
> 
> Some of my GP colleagues would have attempted to
> argue the point, but not so 
> this particular GP. He merely fixed the patient with
> a steely glance and 
> informed him that as he was so certain of the
> diagnosis and treatment of his 
> condition, perhaps he had better find an Internet
> pharmacy to fill his script 
> as well.
> 
> I don't think that the patient has been back to the
> practice.
> 
> 
> > 
> > 
> > I agree with those who responded to my initial
> email, and completely
> > support the evolvement of the intelligent patient.
> However, this is a
> > sensitive issue. Although both patient and
> physician would do well to
> > obtain as much information as possible (whether
> true or as knowledge of
> > quackery), I feel a patient would be wise to
> establish an atmosphere of
> > trust with his physician. As one who has had
> heated discussions with some
> > ignorant physicians, I know that all men are
> created fallable, and that the
> > all-knowledgable sorcerer who can do no wrong, is
> a ghost. Still there is
> > at times a danger that the focussed information a
> patient obtains through
> > the Internet (without the necessary background,
> caveats, or experience)
> > could be detrimental to the realtionship with the
> consulting physician. It
> > would perhaps be more useful to the situation if
> done with the knowledge
> > of, or in consultation with, the physician ("I
> would like to get more
> > information on the interpretation of these results
> from an expert clinical
> > pathologist").
> > 
> > As I mentioned in my former email, I do not put
> any blame whatsoever on Ms
> > Ellis for asking what her results mean, and do not
> believe she would be
> > using our responses to confront her physician. I
> would not like, however,
> > for this network to be used, and interpretations
> to be indiscriminantly
> > used, by patients.   
> > 
> > If one of my staff would come to me for
> explanation of their own lab
> > results, I would definitely use judgement in
> whether I should do so
> > (especially if the result is of a difficult
> prognosis), but be more open
> > since health-care professionals are much better
> informed individuals. I
> > would observe the same care in my replies if asked
> this question by family
> > or friends, and not only if the person involved is
> one of my associates. If
> > I knew that the attending physician was aware of
> the results, and had
> > spoken to the patient about them, I would be much
> more open to discussion
> > of the interpretation. I would also be careful to
> get in touch with the
> > consulting physician and discuss the possible
> ramifications of the lab test
> > results.
> > 
> > I strongly believe in close and complete
> consultation (not advocating
> > submission, but rather cooperation) with the
> physician about his/her
> > patient. I believe that this type of teamwork
> establishes an important
> > professional atmosphere, and enhances, rather than
> delays, the better care
> > of a patient.
> > 
> > Oren Zinder
> > Prof. Oren Zinder
> > Department of Clinical Biochemistry
> > Rambam Medical Center
> > Haifa, ISRAEL  31096
> > Tel: +972-4-854-3767
> > Fax: +972-4-854-2409
> > email:   [log in to unmask]
> >            [log in to unmask]
> > 
> > 
> 
> 
> Dr David G Williams
> FRCPath
> 
>
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=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
Whiston Hospital
Prescot
Merseyside L35 5DR
UK

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