Saturday, 16 May 2009

The Normal

The Brown household takes The Times, and at breakfast this morning I was reading an article by a woman who caught malaria on a holiday in Kenya. She said that her consultant at London's Hospital for Tropical Diseases was surprised because she had taken all the precautions, including Malarone tablets. Her symptoms had been vague, just headaches and falling asleep. Yet she had falciparum malaria.

The article is a useful reminder that you can catch malaria despite taking precautions, and that the diagnosis should always be considered when unexplained illness develops within six months of visiting a malarial area. That is advice which I give to patients when prescribing tablets for malarial prophylaxis, and the more widely it is known the better.

But how had she got to the hospital? In a throwaway line she reports that
my GP referred me "as a precaution".
No doubt her GP used those words in order not to alarm her. Also perhaps because he (or she) was far from certain about the diagnosis and felt a little embarrassed about acting "on a hunch". But that is what GPs try to do: spotting the possibly serious in a sea of headaches and tiredness. It is said that we are experts in what is Normal. We may not know exactly what the Abnormal is, that is for our specialist colleagues to determine, but we try hard to recognise it when it sits in front of us.

There is little glory or prestige in this task. When you succeed the specialist gets all the credit for making the diagnosis, if you fail you are castigated for missing it. But if we had wanted glory we wouldn't have gone into general practice.


Anonymous said...

Ah, great, you are back


And when you timorously send the possible malaria in, and it isn't, the junior docs accuse you of over-reacting

We plod on


Dr Andrew Brown said...

Thanks for the welcome, John. After a little break I think I may now have a few more things to say.

Anonymous said...

Malaria terrifies me.

I grew up in South Africa (white, reasonably privileged, nice house etc), went to a nice school with similarly privileged teachers. In the mid-80s when I was about 14, my history teacher got married and went to Malawi on her honeymoon. Came back and died of cerebral malaria within a week, in our town's excellent hospital. I am sure she took every precaution as well.

Gimlet said...

Great to see you back !!

Anonymous said...

Hurrah, Dr Brown's back on duty!

Petra said...

Welcome back, Dr. Brown... :-D

Blue Spice said...

Just popped by to see if anyone was home - and you are! Wonderful. Welcome back. :)

Webmaster said...

My friend also lives in south africa and he is a doctor also..

Rosie said...

great to see you back - have always enjoyed this blog and as a GP reg it's so nice to see how older and wiser people do it (honestly)

Dr Andrew Brown said...

Thanks everyone for your kind comments.

I'm aware that I've gone a bit quiet again, but I hope to post a bit more soon. There's been quite a lot going on in our practice lately.

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