Tuesday, 24 July 2007

Come Dancing

After a long period of full manning we have just started on the long summer haul, and there will be at least one doctor away for most of the time until the start of October. Fortunately demand is not usually too heavy because many of our patients also go away, or are cheered up by the sunny weather (if and when it arrives). But some days can get a bit busy and it often proves difficult to fit everything in. After ten hours of work I get fed up and just want to go home. So I am doing my best to consult efficiently and keep to time, without making the patients feel I am rushing them or not listening to them. It is quite an art keeping track of where conversation is leading and managing it effectively but kindly. Somehow one has to make sense of the stories and work out what is likely to be going on in the medical sense, in parallel with what is going on in the patient's mind. Explanation, investigation and treatment then has to be negotiated so that it makes sense medically but also makes sense to the patient. We dance in the no-man's land between medical science and our patients' experience. But it has to be a Quickstep and not a slow Waltz!

This week I have seen a young lady who recently had a laparoscopic salpingectomy: the removal of a Fallopean tube because of an ectopic pregnancy within it. The operation had clearly gone well, her abdomen was soft, the tiny scars were healing well and not infected. And yet she appeared to be in pain the whole while, and complained bitterly that her analgesic tablets were not working. “I want something to numb it completely” she said, “I want to block it out”. It didn't take a Freudian genius to work out that her mental pain was greatly exceeding her physical pain. I gently suggested this to her, and she agreed that she was distraught by the loss of a wanted pregnancy and one of her tubes. I prescribed some more analgesics, but I hope that our discussion will also have helped to alleviate her pain. Then it was time to change partners for the next dance.


The Shrink said...

I truly admire GPs who can dance such a dance, my temprement just isn't suited to such frenetic changes! One of my many flaws, I'm in need of more sedate (but involved and often equally lengthy) days.

SAnd as a positive aside, you're continuing to blog with heartening frequency :-)

The Shrink said...

There's a salient piece 'bout reassaurance which I wish I'd known about a good few years ago. It resonates since it's akin to how I manage symptoms now - no matter how bizarre or seemingly trivial it may seem to me it has meaning to my patient.

But dismissing it as medically not relevant in order to curtail consultation time isn't the best way to do things, in order to dance swiftly and adeptly from one partnet to the next.

It's said better than I can here.

Your Mother said...

Do I understand correctly that the next time you come to the waiting room to collect a patient, instead of asking, "Mrs. Smith, will you come with me, please?" you will ask, "Mrs. Smith, will you dance with me please?"


Dr Andrew Brown said...

The Shrink: To be honest, I think the frenetic changes are one of the main reasons that I find things stressful. Each individual consultation can be enjoyable and satisfying, it's the pressure of time and the need to change mind-set so often that cause me fatigue.

Your point about reassurance is well made. I used to teach my Registrars not to make the patients feel awkward for coming.

A Mom Who...: You are quite correct. Shall we dance? :-)