Question:
Who is THE GOOD DOCTOR?
Answer:
That last one!
Greetings and sympathy,
Gerard Freriks
ps. My question and answer are written from the perspective of the patient.
Which is not the same perspective as the one of a good GP !
At 7:22 PM +0100 4/11/98, "Toby Lipman 7, Collingwood Terrace, Jesmond,
Newcastle upon T wrote:
>In message <[log in to unmask]>,
>"Dr.Kumara Mendis" <[log in to unmask]> writes
>>>If only physicians too would allow themselves to admit that they can't
>>>get a diagnosis for everything (thinks - they should spend some time in
>>>GP)."
>>
>>a recent New England Journal Editorial says that nearly 47% of the
>>appendices removed at surgery is not inflammed in USA..... that is hard to
>>beleive (may be the particular surgical unit has problems in diagnosing
>>appendicitis? - but will they allow a person from this unit to write a
>>editorial to NEJM? :-).
>>also ultrasound and CAT can bring down this error to a great extend.
>>but how cost effective is it? the health economists have not had their say.
>>has anyone in UK have similar figures?
>>
>>i think the GPs do not fair that badly? is it?
>>
>I recently had a falling out with a patient (or rather patient's mother)
>over appendicitis. I saw a ten year old as an extra. He'd been seen the
>day before by my partner and had had recurrent abdominal/RIF pain for
>months - been admitted and discharged twice.
>
>During the consultation (in which I did "who is the patient?" and took
>into account psychological if not social factors!) it emerged that his
>mother had recurrent RIF pain as a child and was admitted several times
>("but they didn't do anything"). Eventually she fell into the hands of a
>really bad surgeon who said she had a "grumbling appendix" (ha!) and
>that it must be removed immediately. It was and he told her she was
>"very lucky" as any more delay and it would have been "too late" (ha!).
>
>Anyway, this kid didn't have psoas irritability, he didn't have bad
>breath, he wasn't pyrexial, he had RIH tenderness but no guarding (and
>he seemed remarkably complacent as I pressed into the RIF). I told the
>mother he didn't have signs of appendicitis and suggested 1) wait and
>see and 2) could there be some other explanation? - then prescribed
>pizotifen and arranged to see him in two weeks.
>
>As soon as she got him home the mother rang my partner who was on late
>call and said she wasn't happy. My partner said "is there any change in
>his condition?" and as there wasn't advised wait and see. So she rang
>A+E, said her GP wouldn't visit and took him down. He was admitted, sat
>on overnight and appendix removed in the morning.
>
>She turned up in the surgery demanding an explanation of why Dr Lipman
>was so incompetent (sic), why could the casualty SHO recognise
>appendicitis immediately when I couldn't in 20 minutes (ha!) and that I
>write a letter of grovelling apology and explanation. However by this
>time I was at an EBHC (current PC term for EBM) workshop, tutoring. I
>arrived back to ribald comments of "what about EBM now then, eh?" but
>refused to write the letter until I had seen the discharge summary. This
>duly arrived and read:
>
>"RIF pain, appendicectomy, appendix normal" (ha!).
>
>So I wrote a couple of lines to the effect that my management was
>entirely appropriate, which evidently has the mother spitting blood!
>
>Soon after, I recounted this sorry tale over the garden fence to my
>neighbour who is an anaesthetist, and she told me that when she had to
>gas for surgical emergencies most of the appendices removed were
>normal,and she reckoned only about 30% were modereately inflammed, and
>3% really awful.
>
>So there you are!
>
>Toby
>--
>Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
>0191-2811060 (home), 0191-2437000 (surgery)
Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands Telephone: (+31) (0)174-384296/ Fax: -386249
Mobile : (+31) (0)6-54792800
ARS LONGA, VITA BREVIS
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