Tuesday, July 12, 2011

Get Well or Feel Better Part II

It was barely 8am when I was informed we had a patient in the ER. Male, complaining of difficulty breathing and throat pain among other complaints.

I saw him. He was a typical middle aged man maybe in his 40s. He didn't seem to have any difficulty breathing but he looked a bit anxious.

It turned out that his primary concern was throat pain which he had been experiencing on and off for about 2 months. He described it as extreme dryness of his throat and a sensation that not everything he swallowed would 'go down'. Then he added the other litany of complaints - difficulty breathing, tires easily, various muscle pains.

They say that an accurate diagnosis can be made 80% of the time just from the history. In this case I was fairly sure that he was under a lot of stress, maybe work-related which would explain all his complaints as well as cause hyperacidity which could cause reflux symptoms.

Usually an endoscopy would be needed to confirm my suspicions but due to technical difficulties that wasn't an option at the moment.

Instead I tried to explain what was going on in his body. Illustrations helped a lot. It turned out to be an interactive lecture about physiology in as simple terms as I could manage. If I had a laptop and projector on hand...

Usually this kind of thing makes the patient go, "I don't care about this stuff! Just give me something to feel better!" But apparently several of my educated "guesses" were spot on that he paid attention.

Eventually we came to the part of stress where he volunteered that he indeed had a demanding job and he was stressed out to the point that seeing the long queue for the train ride to work would almost cause him to panic.

It took me longer to talk to him than it took me to suture the wounds of several past patients. By the time we were done he was visibly relaxed (and I was tired)

No medications were given.
He still had his stressful job.
He still had throat dryness.
He still had the sensation of difficulty in swallowing food.
He still tires easily.

He claimed he felt better and the pain had subsided and he was breathing easier. But nothing had changed...
Except maybe the level of his self-awareness.

[PS: An accurate diagnosis can be made 80% of the time with a good history. So there's a 20% chance he'll be coming back mad as hell because I was way of course.]

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