Tuesday, 27 January 2015

Dr google

Hi,

A patient came in today with calf pain he had had for a week after falling off of his bike. After a google to come up with the possible causes for this, he was adamant that he had acute compartment syndrome. This is a medical emergency where the trauma to the limb causes so much swelling it cuts off the blood supply, meaning the tissue becomes more damaged and inflamed due to to the lack of blood. A vicious circle. His leg looked completely normal.

It took me a very long time to try and convince him that Dr google was not in an ideal position to assess his leg, and if he did have acute compartment syndrome his leg would have destroyed itself by now. After 30 minutes of my time he left to try some paracetamol and rest.

Monday, 26 January 2015

Benign Paroxysmal Positional Vertigo


Hi, 


Had a rewarding experience today in GP world - a lady came in complaining of severe dizziness for the last month or so, and I managed to diagnose and treat the condition in about 10 minutes, leaving a very satisfied and surprised patient!

When patients complain of dizziness, it is important to find out what they mean by this - importantly separating out the symptoms of vertigo (feeling like the world is whirling around, like you have just stepped off of a fast merry-go-round)

Not all fun and games

She had these vertigo symptoms when looking up to do her mascara, and when turning over in bed. This is very suggestive of a disease called Benign Paroxysmal Positional Vertigo (BPPV) where there are little crystals in your ears which keep the fluid moving after you stop your head from turning, making it feel as though you are still moving/spinning.

A simple test for this is known as the Dix-Hallpike test, and simple involves having them sit on a couch looking at 45 degrees to one side, then rapidly lying them down - this makes them feel very dizzy and makes their eyes spin in circles (rotational nystagmus). A potential risk of this manoeuvre is you make the patient feel so poorly that they then vomit on you. fortunately this did not happen here!

Because this condition is due to the crystals in the inner ear, it can easily be cured by putting the patients head through a series of different positions (known as Eply manoeuvre). This basically shakes the crystals out of the inner ear and cures the problem.

This is exactly what I did - aided in part by good ol' Wikipedia on my phone by the bedside as I had never done these moves before. It worked wonderfully, these problems which had ruined this patients life for a month were gone after a few minutes of turning around and about. She was able to walk out of the practice cured and happy, very grateful for what I had done. It made my day, being able to cure someone with your bare hands (and the not-insignificant power of Wikipedia!) 

Saturday, 24 January 2015

Time out


Hi, 



I know it has been a very long time since my last post - (months!) but I have been mulling over this GMC situation I mentioned in my last post. I have decided that instead of posting long detailed posts as I have been before I will just post a little story of bit of information that I have been thinking about without background, adding to the anonymous person-and-situation-changing that happens already. I don't want to stop writing things down...

That being said, finding time for writing things down is tough! When I last posted I had just finished my F1 and was starting a rotation in A&E as an F2. I now just completed the 4 month rotation in A&E and am working as a GP now for the next four months. 

A&E was amazing. The breadth of different conditions, learning different skills, and all the crazy reasons for people coming in was great. I looked forward to going into work each day, and perversely, while all the nights and weekends were a bit rubbish, having time off during the week was really nice. Lots of very sick people, exciting trauma situations, people with odd things in odd places and so on. I am now applying for A&E speciality training and have my interview soon. Hoping that this goes well!

Despite all of the 4 hour target pressure and the news about A&E being swamped (it is) I think I am finding my new rotation on GP more stressful. In A&E there is great banter with the other staff, always people to ask to help out, and the sense you are all in it together. In GP I am stuck in my own room, trying to see people every 15 minutes who usually have little wrong with them, but occasionally can be very complex. Trying to pick the complex ill patients from the rest is difficult without any investigations, and trying to manage time to see each patient in about 10 mins (leaving time to do paperwork, referrals, etc) is very difficult. The simple patients who have colds and want antibiotics should be able to be seen in 3-4 minutes, but usually take 10-20 due to all the arguing over the fact that they want drugs. They patient who is suicidal and depressed cannot be condensed down to 10 minutes, and makes everything run late. At least in A&E if you need to spend more time with a sick patient or difficult case you can, in GP it is a real struggle. As you get more experienced working as a GP I am sure this gets easier, but is still a crazy idea.

I think most of the difficulties with being a GP isn't around making complex diagnoses or performing complicated procedures (though there is a lot of scope for these), but it is mainly around communication with patients. I thought I was good at communicating - had dozens of lectures on it at medical school and 'practice' it plenty with friends/at the pub/all the time but this can be a real struggle! 

Either way - I am now applying for A&E, hoping that this crisis in UK hospitals gets better (some good comments on the problems places like this) and now on GP which is much less relaxing than I hoped!
 
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