Friday, 31 October 2008

Lifesavers

In last week's BMJ Professor Trish Greenhalgh was talking about the lives she has saved, ranging from a few heroic events as a junior hospital doctor to the more mundane disease detection and treatment during a career in general practice. Depending on how you define “saving a life”, my personal tally amounts to fewer than a dozen in my entire career - or several thousand. She was not boasting, but making the point that the frequently repetitive and unglamorous work of a GP is just as valuable as the dramatic deeds that go on in hospitals.

Professors are often self confident and ebullient folk, promoting their valuable insights to all who will listen. Doctors are not all like that, and you will not be surprised to hear that I do not recall ever saving anybody's life. I remember a few people dying in hospital despite my best efforts to save them. Although of course some people did get better, despite me being involved in their care. I might have echoed the words of Amboise Paré: I dressed the wound but God healed him.

I believe in the truth of the Jewish saying he who saves a life, saves the whole world and am profoundly moved by stories of brave and selfless people, such as those who saved Jewish children from the Nazis. Anything I might have done myself pales into insignificance.

But recently I did something which made me feel pleased with myself. A chap in his early sixties came along and complained of indigestion for just two weeks. I might have been tempted to give him a bit of antacid treatment and see how things went, but he was not someone who is always at the surgery with an “organ recital” of symptoms. So I packed him off for an endoscopy under the two-week wait scheme. And this detected an early stomach cancer, and he underwent pre-op chemotherapy and then had a partial gastrectomy, and the histology shows that there were no cancer cells in any of the lymph nodes sampled. He is cured!

Now I wasn't involved in any of the clever and difficult stuff at the hospital. I didn't do the endoscopy, devise and administer the chemotherapy regimen, anaesthetise him, operate on him, or nurse him during recovery. All I did was listen, think briefly and make a referral. And yet one could argue that my decision was the sine qua non which enabled all the other activity to be carried out in time.

Alternatively one could argue that the guidelines state clearly that new indigestion over the age of 55 should always be referred for endoscopy. What I did was no more than would be expected, and indeed had I failed to do so then I would have negligently have delayed the diagnosis until it was too late.

But I still feel good about it. Don't destroy my illusions, please.

10 comments:

Elaine said...

No, you are right; it would have been all too easy to prescribe some antacids and "come back in 2 weeks". So, from me, Well done.

Xavier Emmanuelle said...

Well done :)

dutchdoctor said...

Sounds like a great decision from a great doctor. You saved a life.

Dragonfly said...

Goodonya.

Lynn Joy said...

This is great - you are clearly a great doctor. But it gives me confidence in you as an individual and not in the system. For a symptom like indigestion at my surgery, you would struggle to get an appointment, if you did you'd get to see the nurse practitioner rather than a doctor or if you were lucky enough to see a doctor it would be the one that no one likes to see because of his abrupt manner and his strictness around the 10 minute appointment time rule. In the end you'd probably take yourself off down to the chemist and treat the symptom yourself. Sad but true.

steph said...

I have reason to thankful for that guideline also.

I visited my GP recently with recent onset of central chest pain and discomfort, symptoms which were entirely new to me. My GP insisted I should have an endoscopy and when I tried to argue my way out of having any more hospital investigations, he quoted the guidelines (I'm not quite 55 yet) and so I conceded. It subsequently transpired that I had developed a significant gastric ulcer from NSAID's and I'm now undergoing very successful treatment.

I gave my GP a 'high 5' the next time we met!

Blue Spice said...

Continue to be pleased with yourself - you are right. :)

Jellyhead said...

A good call. Thank goodness you insisted on an endoscopy. Your patient must be singing your praises!

Dr Andrew Brown said...

I blush at your kind comments. A small success, but a very real one for all concerned.

daedalus2u said...

That reminds me of one of the letters that Brian Deer got following his exposure of the fraud of Wakefield regarding MMR.

"You have possibly saved more lives tonight than I will save in a lifetime."

http://briandeer.com/wakefield/wakefield-letters.htm

Not every life saved is so easily counted but they are all precious.