Comments on: two satisfying consultations

By: Tazocin

Tazocin — Tue, 12 Aug 2008 18:36:08 +0000

What a lovely post!

I’ve never heard reference to the “flash moment” or Balint before but even as very junior doctor it is very familiar to me and yes, it is so incredibly satisfying when the lightbulbs flash and the clouds part and we understand why the patient really is in front of us right now.

In medical school and intern (PRHO) year I always assumed I’d become a GP… then I worked with a really inspiring Consultant who advised me to pursue General Medical training, I started to listen to all my friends who rubbished the “land of GP” and I found myself applying for Medical SHO schemes (despite having loved every week’s elective I’d ever done in Primary Care).

It’s nice to find blogs with positive descriptions of life in general practice… if I only read John Crippen I’d never consider going back to my original career of choice!

By: Tigermom

Tigermom — Sat, 26 Jul 2008 00:45:04 +0000

Always nice to meet another Nice Lady Doctor.

I am a psychiatrist and the flash moment is so satisfying, and as you say, requires attending to the overt and covert cues from the patient.

Enjoy blogging.

Tigermom

By: Grumpy Scientist

Grumpy Scientist — Fri, 25 Jul 2008 21:37:01 +0000

It’s so interesting to read about the theory of general practice and about your thinking when drawing conclusions about patients. Obviously conclusion-drawing is something that we do in science as well and yet I have little knowledge of the philosophy behind it.

It’s a lovely blog to read by the way – thanks!

By: NiceLadyDoctor

NiceLadyDoctor — Fri, 25 Jul 2008 07:29:39 +0000

Clare – we talked about the risks of x-rays in pregnancy, specifically that the risk decreases in the third trimester, that an x-ray would not have been done if the benefit outweighed the risk, and the small amount of radiation that a wrist x-ray subjects you to compared with, say, a CT scan. Typically a bone x-ray will expose you to the same radiation dose as thirty days of background radiation.

By: Clare Wilson

Clare Wilson — Wed, 23 Jul 2008 20:05:40 +0000

So what did you say to Mrs V that reassured her then?

By: Northern Doctor

Northern Doctor — Wed, 23 Jul 2008 11:59:27 +0000

I always loved doing pulled elbows but you know I have never heard it called nursemaid’s elbow… Quite unusual given the name usually refers to the patient rather than the perpetrator. I am trying to think of any other examples but the only one coming to mind is a hangman’s fracture! My kids haven’t suffered any elbow injuries yet despite a couple of emergency manoeuvres executed on them when they threw themselves into the path of passing traffic. However, my son does sport an impressive scar on the back of his neck where he was ’scruffed’ by his mother as he tried to escape.

By: Andrew Brown

Andrew Brown — Tue, 22 Jul 2008 20:17:25 +0000

Beautifully written. Thank you.

My experience is that reducing radial head dislocations is not always as obviously successful as you describe. There may not be a click, the patient goes away crying a bit less and using the arm a little more, and I tell the parents to bring him or her back if things don’t settle.

Usually they don’t (and don’t go to A&E either), but it isn’t quite as satisfying for the pore ole doc.

By: Jobbing Doctor

Jobbing Doctor — Tue, 22 Jul 2008 19:55:53 +0000

Yes – the pulled elbow is quite simple and immensely satisfying to treat. The results are instantaneous.

The second is an example of where you, as doctor, just let the patient talk and they will give you the diagnosis: in this investigation-focussed profession, the history gives you the answer 80% of the time.