"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!
Thursday, August 14, 2008
Friday, July 25, 2008
The Unwanted Child: Part 2
As a followup to my earlier post, The Unwanted Child, I thought that I would link to more recent reports in this case.
Basically the parents have been unsuccessful in their lawsuit, and I breathe a sigh of relief (as a medical professional). For more information, follow these links.
Basically the parents have been unsuccessful in their lawsuit, and I breathe a sigh of relief (as a medical professional). For more information, follow these links.
Tuesday, June 24, 2008
Heart Check? Blank Cheque! Part 2
ACA - Heart Check ConLast year, I wrote a blog entry entitled Heart Check? Blank Cheque!.
It looks like our good friend, A Current Affair, has put their "investigative skills" to the case and done a slag piece on Heart Check. Please note that I had absolutely nothing to do with this - but I don't feel the least bit sorry for them.
Clearly this piece has had more effect than my blog entry, as this Heart Check Clinic Manager reports in her blog. Hopefully it has had no involvement in her marital difficulties.
Click on the image above to see the ACA video.
Monday, June 16, 2008
Pssst! Pass it on!
A few months ago, one of my private patients took a turn for the worse. She had had a minor procedure which had gone smoothly. Unfortunately, in the several hours after the operation she developed some bleeding under the wound. I was not notified.
I returned the next day to find a tennis-ball sized haematoma, five layers of gauze and combine reinforcement, and a drain bottle that had fallen out. Multiple entries were made in the notes of the increasing haematoma, but no attempt made to contact me.
The patient was, thankfully, not upset or distressed. She was in some discomfort and agreed with me that the safest thing to do would be to return to theatre to evacuate the haematoma later that day.
Unfortunately, my secretary spent the better half of the day trying to track down an anaesthetist without success. Such is life in the private sector. Most private hospitals do not have on-call rosters, because most surgeons have direct relationships with anaesthetists that they use regularly. Unfortunately, none of mine were available at short notice, and in this situation you have to scratch around for anyone who is available and willing to come in after hours for a half-hour operation that doesn't pay very well.
After making some more phone calls myself, I managed to find a friend of a friend of a friend who was available to come in for the case. It was a simple job. A light anaesthetic, a small cut. A gentle squeeze and a few spots of diathermy. A drain tube was repositioned and the wound closed with interrupted sutures. We were all in and out of there in under an hour. The anaesthetist was jovial and friendly, and genuinely helpful. He made a point to give me his business card so that I could "Call me anytime."
As I was writing up my notes, however, one of the anaesthetic nurses approached me. "Doctor, I'm not sure whether you know, but there's a reason Dr Anaesthetist is usually available for these cases. Apparently a few years ago he was involved when some Fentanyl went missing from the DD (Drugs of Dependency) cupboard."
It turns out that the rumour was widely known - over a period of several months, the drug cupboard counts were intermittently short one or two ampoules. Not on a regular or frequent basis, but allegedly usually after a list involving this anaesthetist. It was said that he had been questioned by administration but no action taken. Since then no more drug counts had been suspicious. But the implication was clear. The anaesthetist is, or was, a drug addict.
This was a terrible allegation against an anaesthetist. It was an unproven one. No charges were laid, no disciplinary action taken. Not enough evidence existed to involve the Medical Board. All that was left was circumstance, gossip, and rumour. And a reputation that was now shattered, a career decimated.
Apparently work dried up. Lists were dropped. Phones stopped ringing. In response, this anaesthetist was forced to scrounge around for work. He had no public appointments to fall back on. He had no ICU experience to rely on. He put his name down at every private hospital in town for emergency anaesthetic work. He never said no to a case. But he had no regular lists.
I struggled with the thought of whether I should use him in the future. He seemed nice. He was competent (albeit anyone can be competent when the job is simple). The allegations were just talk and innuendo. But if they were true, how could I entrust my patients to his care? If they were false, how dare I prejudice someone based on rumour?
I never used his services again. I tell myself that it was not because of what was said - I have my regular anaesthetists, and a situation like that has not arisen since. But I feel terrible. His business card still sits in my desk drawer. I always think whether he is surviving. Occasionally we hear about an anaesthetist overdosing - I always wonder whether it is him. I have done nothing, and yet I feel guilty. That has been my secret.
I returned the next day to find a tennis-ball sized haematoma, five layers of gauze and combine reinforcement, and a drain bottle that had fallen out. Multiple entries were made in the notes of the increasing haematoma, but no attempt made to contact me.
The patient was, thankfully, not upset or distressed. She was in some discomfort and agreed with me that the safest thing to do would be to return to theatre to evacuate the haematoma later that day.
Unfortunately, my secretary spent the better half of the day trying to track down an anaesthetist without success. Such is life in the private sector. Most private hospitals do not have on-call rosters, because most surgeons have direct relationships with anaesthetists that they use regularly. Unfortunately, none of mine were available at short notice, and in this situation you have to scratch around for anyone who is available and willing to come in after hours for a half-hour operation that doesn't pay very well.
After making some more phone calls myself, I managed to find a friend of a friend of a friend who was available to come in for the case. It was a simple job. A light anaesthetic, a small cut. A gentle squeeze and a few spots of diathermy. A drain tube was repositioned and the wound closed with interrupted sutures. We were all in and out of there in under an hour. The anaesthetist was jovial and friendly, and genuinely helpful. He made a point to give me his business card so that I could "Call me anytime."
As I was writing up my notes, however, one of the anaesthetic nurses approached me. "Doctor, I'm not sure whether you know, but there's a reason Dr Anaesthetist is usually available for these cases. Apparently a few years ago he was involved when some Fentanyl went missing from the DD (Drugs of Dependency) cupboard."It turns out that the rumour was widely known - over a period of several months, the drug cupboard counts were intermittently short one or two ampoules. Not on a regular or frequent basis, but allegedly usually after a list involving this anaesthetist. It was said that he had been questioned by administration but no action taken. Since then no more drug counts had been suspicious. But the implication was clear. The anaesthetist is, or was, a drug addict.
This was a terrible allegation against an anaesthetist. It was an unproven one. No charges were laid, no disciplinary action taken. Not enough evidence existed to involve the Medical Board. All that was left was circumstance, gossip, and rumour. And a reputation that was now shattered, a career decimated.
Apparently work dried up. Lists were dropped. Phones stopped ringing. In response, this anaesthetist was forced to scrounge around for work. He had no public appointments to fall back on. He had no ICU experience to rely on. He put his name down at every private hospital in town for emergency anaesthetic work. He never said no to a case. But he had no regular lists.
I struggled with the thought of whether I should use him in the future. He seemed nice. He was competent (albeit anyone can be competent when the job is simple). The allegations were just talk and innuendo. But if they were true, how could I entrust my patients to his care? If they were false, how dare I prejudice someone based on rumour?
I never used his services again. I tell myself that it was not because of what was said - I have my regular anaesthetists, and a situation like that has not arisen since. But I feel terrible. His business card still sits in my desk drawer. I always think whether he is surviving. Occasionally we hear about an anaesthetist overdosing - I always wonder whether it is him. I have done nothing, and yet I feel guilty. That has been my secret.
Sunday, June 15, 2008
Grand Rounds (4) 38 and SurgeXperiences
Dr Crippen at NHS Blog Doctor posted this edition, and along with QuietusLeo at The Sandman, kindly included my last post on organ donation.
Please go and read them - they are fascinating links as usual.
Please go and read them - they are fascinating links as usual.
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