Complacency in general practice

Friday has arrived and with it I celebrate my 20th blog entry. Quite a milestone. It has been quite enjoyable typing this blog every weekday for the past 4 weeks and long may it continue. Being Friday means, as you all know by now, I am shattered! It is so difficult getting up in the mornings on Friday. Thank God it's a half day - my next job, starting in February, will be in A&E, and my hours then will be absolutely crazy, something I am not looking forward to at all! I'm guessing it'll be extremely difficult to keep my blog up-to-date. But, for now, that's a long way away.

I mentioned yesterday that I haven't spoke about my work for some time, mainly because not much interesting has happened. One thing I've noticed is that the cold season is upon us! At least 50% of my consultations are people with a cold, blocked nose, cough, feeling 'fluey.' All turn up after a couple of days of feeling run-down and all receive the same advice! "It takes time to get better, continue with rest, fluids and analgesia!" Pretty straightforward, but no-one seems to try that first. I really appreciate it when patients come in having tried all that without any improvement, which would suggest more serious infections, and I can then actually help them get better.

Unfortunately, sometimes this leads to complacency on my part. Due to the repetitive nature of the complaints, repeating the same advice gets tedious and can lead to mistakes. Such an event occurred last week. I saw a gentleman whose main complaint was earache for the last couple of days preceded by feeling 'fluey.' Like most patients, he hadn't taken anything for the pain and wanted it checked out. I automatically assumed the earache was a result of the untreated cold he was suffering from and began my usual spiel about getting plenty of rest, taking painkillers and see how it goes.

I then looked in his ears; they were bunged up with wax, so much so it was visible on the outside. It was a surprise he could hear what I was saying! It's not usual to have so much wax so I spoke to my trainer for some advice, who also checked it out. At the same time he noted that he was sweating profusely and was tachycardic (fast pulse rate) which suggested that something more serious was going on. I checked his blood pressure which was raised and he had a temperature of 40C. My trainer pointed out that he was diabetic, something I had forgotten to check! This all pointed to a severe infection which could lead to serious damage, especially in his ears, because of the diabetes. He needed a long course of some pretty strong antibiotics.

I saw him again this Monday and thankfully he was much better, the wax was still there, but he no longer had a temperature and his blood pressure was normal. Now, in my defense, I would like to think that I was about to check the temperature and pulse after consulting with my trainer about the ears and would've picked up on the severity of the infection. I should have realised he was diabetic, but the trainer had the advantage of knowing the patient for quite some time and already knew his medical history. What I was disappointed with was my attitude. Each patient is different, and I should never have gotten so complacent. In my head, as soon as he explained what the problem was, I was getting ready to sputter out the same advice and move on to the next patient. It was a good wake up call, because no damage was done and the patient improved.

Incidentally, the next patient I saw also had a cold, but also had had a splenectomy (spleen removed) when she was a child and hence had no defensive barrier to infection. She had to go to hospital for further investigations and a course of intravenous antibiotics. My attitude was different from the beginning of the consultation, and although I wouldn't have missed the importance of her condition had I seen her previously, my whole outlook was much better.

I guess it's important these events happen, as long as nothing too damaging come about from it. The problem arises when any complacency leads to mistakes which then lead to the ultimate mistake - death! Thankfully, that has never happened, but I need to make sure that I do my best all the time to ensure the risk of that happening is kept to a minimum!

Take care all, and have a good weekend,
Thoughts just flow, when do they have to make sense?