Thursday, August 14, 2008

Scan Me, Scan You

"Mrs Burns?"

40 heads turn around in the outpatients waiting area as I call for the next patient. "Mrs Burns?"

A chubby elderly lady stands up with her daughter and they make their way into the windowless consulting room.

It's a fairly standard consultation. Her GP has referred this moderately obese woman in her late 50s with two episodes of colicky abdominal pain over the last six months. An ultrasound shows some small gallstones but no CBD dilatation. LFTs are normal.

It's clear that the problem is not reflux, and it has only happened twice - after Christmas dinner and a big Easter Lunch. Diagnosis: Biliary Colic.

"There's really no need to worry, Mrs Burns. The likelihood is that you will get some discomfort, maybe some diarrhoea, if you eat a very fatty meal, such as fried food. There's a very small chance that the stones could block the bile duct or gall bladder and that you might get inflammation or infection, in which case you would get quite unwell and should come to the Emergency Department. Otherwise, I would only recommend surgery if you were to develop frequent pain whenever you eat."

"Are you sure it's not cancer?" says the daughter. "My boyfriend's father's second cousin's next-door neighbour had pain like this and they found a cancer in his pancreas. He died in agony after five operations. They say it's a hidden killer."

I struggle to keep a straight face. "There is no reason to think that a cancer is there. Your mother's bowel actions are normal. Her weight is, er, stable. The blood tests are normal... at this time. I think it is just the gall stones. I'm happy to keep an eye on things, and if things were to change then I'd consider a CAT scan, but there's no reason to do that now."

"Wouldn't it be too late if she had symptoms? Why not scan her now? We don't want to end up like that bloke on the news." I sigh, silently to myself. Last week a poor chap died of a subarachnoid haemorrhage because the experienced ED physician decided that a 35 year old man with a long history of migraines didn't need yet another CT brain for yet another headache.

I could give the spiel about unnecessary radiation exposure. I could talk about blowing out the public healthcare budget and our taxes on inappropriate investigations. Or I could reach for the request slip.

"Leave the young man alone, dear. He's told us what the problem is. Don't you trust him?"

I smile to myself as I show them the door. The patient herself has let me off the hook, and highlighted the inter-generational change in "health consumer" behaviour. I cross my fingers and hope I'm right.

That was my 100th blog post. I realise that as an irregular blogger it is challenging to build up a large readership but I hope that those of you who happen to stumble upon my blog find it interesting and thought-provoking. Please keep up your comments, as that is the only way to know that somebody actually reads my blog!


Anonymous said...

Congrats on 100!
Great to pop in and see your thoughts and musings

Anonymous said...

Amazing tolerance on your behalf. It boggles the mind that patients bother to take our time and come for our advice, only to find out they had actually made up their minds before walking through the door as to what their management should be.

Anonymous said...

I'm reading - and I'm hearing you. I've an outpatients session tomorrow, and you've made me dread it even more now!

The Caffeine Lady said...

Always reading. I check back every few days to see if there's an update.

Milk and Two Sugars said...

Still here, still reading!

Sheepish said...

Dear All: Thanks for your support! I will definitely keep blogging away!

make mine trauma said...

I'm more of a lurker type, but I will try to comment more often. I know what you mean, Please keep up your comments, as that is the only way to know that somebody actually reads my blog! You begin to wonder, Is this thing ON? When nobody comments it feels like, why bother!

Dragonfly said...

Happy 10th post!

Anonymous said...

Sorry for the anon post but I just wanted to say that I hope you are planning to continue blogging, and soon :)

therapydoc said...

Not only do I like it, but I'm coming back for more and will link to you, too.