I am a General Practitioner. I may not be an expert at one thing but I know something about diverse medical specialties and feel at home in the private, public, voluntary and community sectors; about broad determinants of health, about lifestyle choices people make and helping them make informed decisions, about treating a breadth of illnesses and knowing when to listen and do nothing; when to refer, when no pill may bring relief while FP10s (prescriptions) may hurt; (not) making mistakes and learning lessons from (other people’s) mistakes…
That’s the beauty of being a generalist – especially the management of risks. Last week, I saw a child whose parent brought him to see me within one hour of abdominal pain. The child was pain free by the time I examined him. Another child had a high temperature which started that morning. It was down by the time I saw her. Both children had very intelligent parents and none of them had been given Paracetamol before or after the urgent appointments was made. Self care. Not.
The next patient had symptoms that were very vague. Not feeling very well for some days. Upper abdominal pain that had subsided. Nothing else, except a relatively fast pulse on examination. She was exceptionally grateful for the care. I was saying to myself, “I have no clue what’s going on here yet this woman is so thankful for the care (or its lack thereof).” I ordered urgent blood tests. Could it be an infection? I had once missed a heart attack which presented as indigestion in a patient on long-term treatment for stomach ulcer. That also plagued my mind. The ECG I shortly had to hand, was not diagnostic but I called the paramedics anyway. They looked at the ECG as if I was a time waster. I was relieved they agreed to take her into hospital.
Two hours later, I checked the hospital laboratory results website – my patient had a heart attack by the very high test results. “Trust your hunches. They’re usually based on facts filed away just below the conscious level.” – Joyce Brothers.
As I drove home, tears of relief rolled down my eyes. I could have sent someone home who was so grateful for my care, despite suffering a silent heart attack! Life in General Practice is never black or white. There is the occasional spot diagnosis – subconjunctival haemorrhage, chalazion, molluscum contagiosum, seborrhoeic keratosis, mucocele of lip, Baker’s cyst, etc. Majority of presentations are along the grey scale and in trusting one’s hunch there is the additional benefit of knowing the beautiful name – the name of Jesus Christ, who is Alpha and Omega (knowing the end from the beginning) and Omniscient (knowing all things).
I can understand if you scoff at the mention of the beautiful name. The taste of the pudding is in the eating. I once watched a Ganja man being interviewed on TV. I still remember him saying, “When you smoke ganja, you are lifted up. You can see God!”
As I drove home that night, I thanked a different God for answered prayers. On my way to work every morning, I pray for divine guidance; to see, hear and speak to all my patients, staff and colleagues as an ambassador of heaven and to have the mind of Christ. This ‘near miss’ is one of countless examples of the workings in my life, of He, who has that beautiful name and is able to keep you and I from falling.
Abiye Hector-Goma
Partner, Allerton Medical Centre, Leeds, U.K.