Week 2 Family Med, Soapbox

better yesterday. i still stammer and grope for simple words and phrases, but my physical exam skills occasionally come up with something good. i caught 2 hernias yesterday (not the "oh, my" kind, but just umbilical ones) and a heart murmur that you could practically hear from outside the room... but i got a nod from the MD for catching it (and grading it correctly- woohoo!) anyway.

that one was funny because the little old lady i heard it on was a wee bit demented (but really charming) and said she had no idea anything was the matter with/different with her heart and if i just asked the doctor, she was sure he'd give me a clean bill of health. well, i did ask the doctor about it, and it was very much a known problem that had hospitalized her previously and one that they had discussed surgery to fix. we all 3 discussed it when the MD came in and she said, "well, i guess that's just something the doctor has been keeping to himself." i think things like valve stenosis get easily forgotten by patients if they're rarely symptomatic or don't require any meds to manage. it's not like they're listening to their own hearts. but, if she had gone to a clinic/ER that didn't know her hx and she'd told them she had never had a problem w/ a murmur, they would have thought it was new and done a complete workup, maybe focused on it and missed other things, etc.

this is why i strongly encourage all patients w/ a significant medical hx to keep a little list in their wallets of all their allergies, meds (up to date!!), MD names, known conditions, and past treatments/ surgeries with dates. i know this tirade is boring, and i apologize, my dear bloggies. but it's difficult and dangerous when a patient show up at a random ER or clinic where the practitioners don't know him from Adam and he doesn't have any of his health hx on him. that's all i'll say about that. maybe i'll write my congressman. :) or make a PSA about it. perhaps i can get one of the cast members from "grey's anatomy" or maybe hugh laurie from "house" would do it.... he could say something like "Figuring out a diagnosis is enough of a puzzle, it sure helps the doctors to have all the pieces. Carry a current health info card on your person at all times. it could save your life." ooh-i like that. he could really take home the last line by pointing his cane at the camera. hmmm....now i just have to figure out how to break into his house and convince him to agree to do it. hey, now...."kidnap" is such a strong word....