The future of healthcareLearn More

An illness is never minor when you’re ill

After 20 years in practice I’d never seen one of these in my career. Until that day. It’s called a quinsy. Essentially an abscess deep in the throat. Not really surprising because according to a recent review:

Most patients with quinsy develop the condition rapidly, and many do not present with a respiratory tract infection to their GP first. BJGP

The incidence is estimated to range from 10-41 cases per 100,000 per year. It’s unusual to see a case in practice. Given Australia’s 23 million people you’d expect an incidence of about 2,300 cases per year nationwide. Similarly I consulted a young child with nephrotic syndrome, similar incidence (3.6 per 100,000). Both cases were referred to hospital as emergencies. The odds of seeing one of these is in the same order of magnitude as being struck by lightening in your lifetime.

On the other hand in the same week I saw several people with:

I also saw a victim of domestic violence:

Just under half a million Australian women reported that they had experienced physical or sexual violence or sexual assault in the past 12 months. Domestic violence prevention centre.

And a drug seeker:

Australian GPs write more than 15 million prescriptions per year for drugs known to be misused, with the main prescription drugs misused currently being narcotic analgesics and benzodiazepines, as well as stimulants, barbiturates and other sedative–hypnotic agents. Martyres et al

So apart from quinsy and nephrotic syndrome (both of which I recognised) I spent most of my week managing conditions that didn’t need to be referred to specialists.  And yet the people who were offered reassurance or simple and effective treatment for their ailments were immensely grateful. Every day general practitioners provide this service to the community. They save lives by identifying people who need urgent care but much more than that they make the lives of the community so much more tolerable. There is no such thing as ‘minor illness’.

The last word has to be on pityriasis rosea:

I finally found out what the rashes on my back, arms, torso, and now my foot are. I have herolds patch too. I hate it! I can’t stop scratching. It took 1 hospital visit and a trip to my doctor to find out what this thing was. The doctor at the hospital thought the big round patch was a ringworm and he thought all the other small rashes that had just appeared was scabies. I was terrified..did some research on scabies and tried to treat that myself. Then I decided to just go to my doctor and he told me it wasn’t scabies…and showed me a picture of hereld’s patch. He knew what it was right off the bat. I guess there is no cure for it and it just goes away by itself. I just wish I could take something so I can stop scratching. SkinCell forum

Picture by Col.Sanders

The chasm between patient experience and clinical practice

Can you guess what this abstract relates to without clicking on the link: ABC is advisable if the patient does not show sustained improvement after a year of active treatment by other indicated means. The operation often represents the turning … [Read more]

Why general practitioners are crucial to the economy

The odds of experiencing an event that will descend you briefly into your own private hell are significant. Flu: 1:20 to 1:4 Sprained ankle: 1:100 Rib fracture: 1:1000 Low back pain: 6-15:100 Hayfever: 8-14:100 These odds are much … [Read more]

Continuity of care is a good thing right?

There's a wonderful video that illustrates the point I'm making this week. You can see it here. It is assumed that continuity of care is a good thing. That if you consult the same doctor every time then you will benefit with better health. We all … [Read more]

How to get your doctor to do what you want

I had no idea who he was other than a name in the appointment book and an address on some street I had never seen. What did he do for a living? Who was his partner? What was his home like? Where had be been before with this complaint? What was he … [Read more]

Who are you and what do you do for a living?

It was a dangerous time to be a forklift driver. One day I saw four of them each reported gastroenteritis. Now recovering but not fit to go to work. Or so they said. They were not related in any way, not even working in the same place and each had … [Read more]

Are we allowing technology to hamper healing?

You've heard it before I'm at that age doctor when I should have a full body scan. Like it's being offered here. or at the very least Can I have a scan doctor? When offered radiological tests immediately the public is led to believe that such … [Read more]

Biomedicine falters when it ignores our messy lives

What this mum needed most was a good nights sleep. I proceeded to examine her smiling, curious, well fed, active infant. He reached up and grabbed my stethoscope than raised an eye brow and looked into my eyes and cracked a gummy smile the way babies … [Read more]

Profiting from vanity- they may be targeting someone you love.

Where I live you'd be forgiven for thinking that you will be reported for child abuse if your teenager has less than perfectly straight teeth. Kids are growing up believing they need to be physically perfect.  So when the first crop of zits appears … [Read more]

Common sense vs. miracle cures

I've seen this person, or someone like her many times before. On that occasion it was a demand for phentermine but it could have been antibiotics, 'blood tests', a 'whole body scan', benzodiazepines or opiates . My doctor has prescribed it before. I … [Read more]