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The Very Informed Patient

GPs have a label for people like you and me. People who Google things. People who come to the appointment, armed with the information already. They call us the Very Informed Patient or VIP. Personally, I quite like that. It could have been worse. We used to be known as the ‘PITAP’. But that was before GPs were under pressure to tick boxes for numbers of patients seen, weight checked, cholesterol checked, blood pressure controlled and stop smoking!

Now consultations are less about what is worrying you, the patient (because you already know what it is and how to treat it), and is more about the GP being able to score points (and points equals money) by asking a few simple questions.
Four months ago, I fell over/down a farm stile. It was neither elegant nor pretty and was extremely painful. But being a robust sort, I ignored it. Until I couldn’t walk, sit, stand, lie down, lift anything. Yes, it was that bad. I made an appointment with a super physiotherapist and started treatment. I didn’t even think about telling the GP. I had a prescription review due so mentioned it to him. He wasn’t too concerned, but instead remarked on my weight and blood pressure. Both affected by my lack of mobility and being in some pain. Thankfully, I didn’t take it to heart, carried on with the physio, who got me back to full fitness in 6 weeks. And the weight went back to normal, along with the blood pressure; no surprise really as I was back to my exercise routine too.
The point is this – my back was injured, I was taking painkillers and had limited mobility. Was this really the most appropriate time to lecture on weight?
Around the same time, cuts to NHS Direct were announced, and a new scheme introduced, the Isabel Symptom Checker. I entered the term back pain, and clicked on back pain lower. The first time I did this, I was told rather alarmingly, that the top cause of lower back pain was a malignant bone tumour! Well, I knew it wasn’t that, and anyway, they are very rare. Today, the symptom checker has improved, so while it still lists bone tumours in the top 10 causes of lower back pain, it does have slipped disc at number 1. Still a rather alarming list of symptoms, and hardly what the GPs will want to see waved under their noses.
Isn’t it time, then, that we went back to that old-fashioned examination and diagnosis, based on clinical skill, not just the internet and a barrage of blood tests and investigations.
Which brings me to my next point – VOMIT. More and more of us are becoming victims of modern imaging technologies. Often, when diagnosis is tricky, or treatment is taking a bit longer to work, we put our GPs under pressure to investigate further. In most cases, GPs have to refer to specialists to order CT scans or MRIs. These are actually quite invasive tests, not to be undertaken lightly. Still suffering from the back pain, and a rather stubborn sciatic nerve upset, the physio started to second guess her initial diagnosis. Perhaps the fall I had had, was masking something more sinister. Perhaps I had a slipped disc, or worse, after all. Perhaps I needed an orthopaedic consult. Dr B, being a cardiologist, has a healthy scepticism for specialists other than physicians, and suggested a further physio assessment. And would you know it, she discovered another area of injury. Within days of treating this injury, I started to heal. It didn’t take long after that to be back to full fitness. I shudder to think what might have been my journey if I had ended up in the orthopaedic department.
Sometimes, a little knowledge does help the process. Sometimes, taking a common sense approach, asking a few more questions, gets to the right answer a little quicker.
This post was previously published on my blog To science and beyond.
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