Patients, learning, stories

Let loose on the wards having been in psychiatry, general surgery, oncology, infectious diseases, neurosurgery and neurology. It's good to see patients and turn conditions learned in text books into a real clinical picture!

Seeing patients is what you remember, there are patient presentations that will stick around but more than that its also the stories.

Today I met a lovely chap referred to a neurology clinic with dysarthria (slurred speech), difficulty swallowing and a cough - all in all just not quite right. He gladly gave a good history and was examined. When he was asked about what might be wrong - he divulges using the bible that is Wikipedia for his symptoms.

He looked pretty sheepish telling the doctor this - which I think is interesting. In an age where we can google anything, it's no small wonder patients will use to it find out something as daunting as a "diagnosis". Now, this information wields a fair bit of power...and like power it can go two ways; either like Jeremy Clarkson - ending up in a cloud of smoke or the Stig navigating the same track in the same high powered car. Sorry for the poor Top Gear analogy

This chap actually took wikipedias finest diagnosis of Motor Neurone Disease and gave him something to think about. Credit to him, he just asked the consultant who said it was something to think about. He then explained he was the sole carer for his wife and it was good for him to plan ahead. I think he was a Stig, he left the room in good spirits and well informed.

With every Stig there is always a Clarkson. For example an MS patient, who has tried multiple treatments with not much success. They search for an alternative, any alternative to google! - and they stumble across an article singing praises of this new drug. When this is broached to their doctor they happily look it up, unfortunately its not licensed. After a lengthy submission on behalf of the patient under exceptional circumstances - it's declined. The patient is naturally crestfallen after built up hopes and leaves a sticky doctor patient relationship.

I really sympathise with patients looking for an answer - presented with a shiny high powered car it looks so hopeful. How do we stop patients heading for a "crash"? Well in short I don't think the medical profession can really - everyone can do what they like!

I think the Internet is fantastic - but is also a double edged sword. This new group of educated patients presents a new challenge in consultation skills. Dealing with the Clarksons and Stigs of the world is probably not going to come up in a communication skills session. However I think it's definitely food for thought next time you look up a medical condition on Wikipedia.