If you go to a wedding, chances are, someone will ask you ‘what do you do?’. If you fall into the trap of telling them you’re a Doctor, a further question then swiftly follows:
‘What kind of doctor?’, they ask you. Two minutes later, you may end up having an uncomfortable chat about their piles. If you’re lucky, you might be asked if you have ‘ever treated somebody famous?’ +/- their famous piles. At that stage, it’s probably time to find the bar, or someone’s Granny to dance with.
What about those folk who are supposed to know us?
Do your friends and family actually know what you do?
I’m willing to bet, your kith and kin will have a scanty idea of about your kind of medical alchemy, but would dry up soon if you pressed them. So, when it comes to our patients, they can be probably be excused for being even more clueless about what we like to see and treat, and the breadth of our skill set.
Why is this important?
You might argue that if you are working in a hectic NHS clinic, you’d rather quite like the idea of playing dumb and not squandering anymore precious clinic time on a patient who asks you a question which is a little “off piste”. (I’m sure intellectual curiosity may get the better of you in the end, however.)
In the private sector, we have the privilege of a little more time. Nevertheless, it’s interesting that patients hold back from telling us valuable information which could be potentially useful diagnostically because they figure it doesn’t fit within our remit.
Let me give you an example…
I love seeing patients who have got hip and pelvis problems. I recently saw a patient with long-standing buttock pain. (Believe it or not, that presenting complaint makes my heart sing). He had been referred to me with a ‘locked SIJ’ and the referrer wondered ‘if this might be a case of early onset hip osteoarthritis resulting in mechanical SIJ changes?’
Given the patient’s age and his symptoms – pain which seemed better with exercise, I asked about other conditions such as bowel disease, psoriasis, and eye problems which might point to this being a seronegative arthropathy. The patient denied any of these co-conditions. I popped him in the MRI scanner, sent him for some bloods, and saw him a few days later.
At the follow up appointment, we reviewed the imaging. Lo and behold, he had SIJ changes on imaging that were classical for an inflammatory cause. Not giving up easily I inquired again as to whether he had any other inflammatory conditions? He finally `fessed up’ to having recently been to Moorfields eye hospital with what sounded very much like uveitis.
Somewhat puzzled, I enquired of him “didn’t I ask you about eye problems before or did I just forget to?” He sheepishly replied, “Yes, you did, but I didn’t think it was relevant because you’re a sports doctor”.
The moral of this story:
Patients adapt their history according to what they think we will want to deal with.
Let’s educate our patients more about what we actually do, and while we’re at it, let’s tell potential referrers, friends and colleagues too.
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