Wednesday, April 19, 2006

Another Lesson

The chief complaint, they teach us in medical school, is the portal to the patient. Like the window to their soul. All else should follow from there. It makes some sense, in that at very least, one needs to address the patient's main problem, and that you shouldn't ever loose sight of that main problem.

However, like all dogma, it breaks down in the chaotic system called reality.

I had a woman with a headache. That was her chief complaint. OK. But on exam, she shows more than the usual vagueness. She has had headaches all of her life, but she can't describe them at all. In fact, there's something clearly wrong with her story because there's clearly something wrong with her. She's completly confused. So I abandon the chief complaint and focus on the real problem.

Which is something that comes with great difficulty. It actually goes against all the medical dogma. I'm in uncharted waters. I'm the religiomaniac who reads and understands Darwin. This makes good sense, yet it must not be. One mustn't ignore the chief complaint.

So I send her to the ER, where labs show she is in renal failure. Dogma falsified becomes... Tradition?

3 Comments:

Blogger echrai said...

Good thing you're willing to take that most frightening of all steps... I've heard more than one instance where the patient would be much much worse or dead if the doctor hadn't shucked dogma to one side and taken a leap to help someone. While there's something to be said for dogma, all things should be taken in moderation, including moderation itself. The ability to take chances is truly what sets the good doctors apart from the bad. (renal failure, UGH! How dreadful!)

1:42 PM  
Blogger marybishop said...

Renal failure and all she could say was she had a headache? Good thing you ditched the dogma.

3:18 PM  
Blogger Peg Spencer said...

Good job, Doc NOS. Good thing she had a headache, to bring her in so you could steer her in the right direction.

2:13 PM  

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