Over medicalisation

Finally I seem to be getting a bit of interest in my blogs. Got a detailed comment yesterday to my blog on Monday to which I've just replied and also Sully made an appearance on the comments board. Sully, I'll be typing about you in due course, let's just say it'll be very funny! Meanwhile, I completely forgot to mention the fact that I've been blogging for over a month now! 18th Oct was the one month anniversary! It's been a lot of fun so far, let's hope it continues.

Being Friday means a brief blog before I finish work and get some sleep! I want to talk about a couple of cases I encountered during a stint in A&E last year. The first was a 75yr old gentleman who had collapsed at home having recently started a new antihypertensive (blood pressure) tablet. By definition, the tablet works to lower the blood pressure and he had been prescribed too high of a dose which cause him to drop his blood pressure too much and collapse. In A&E he was referred to the medical doctors, who admitted and observed him overnight, ran some blood tests, performed an ECG which was normal and discharged him the next day after stopping his medication.

The other patient presented with diarrhoea and vomiting for 3 days and could no longer keep her food down because of the nausea, but was able to drink. She too was admitted and kept overnight. She received an intravenous drip of fluids to rehydrate her and her stool was cultured to make sure there wasn't any severe infection. It took 3 days to come back, so she remained in hospital for that long and the result showed nothing. The likelihood was that she was suffering from food poisoning caused by a virus.

Now, the reason I mention these two cases is because this week, I saw something similar in the practice surgery. The first was a 70yr old gentleman who had recently started a new blood pressure tablet and promptly fainted at home. I discussed it with my trainer; we stopped the medication, reverted to what he was originally on and sent him home, advising him to return if there were any problems. The second was a 65yr old lady who had developed diarrhoea and vomiting over the weekend and couldn't eat any food because of the nausea. I prescribed her some anti-sickness tablets and Imodium to stop the diarrhoea, advised her to get plenty of rest and to drink lots of fluids to rehydrate herself. I phoned her yesterday afternoon, and she was feeling much better and could eat again.

So, very similar presentations, totally different management. The patients I saw over a year ago were over treated, and I suppose you could argue that the patients I saw this week were under treated. However, these were relatively straightforward cases with straightforward solutions. The patients who presented in A&E could easily have been dealt with in the same way as I had done this week.

The problem is that the patients in A&E were over medicalised. They now probably have certain expectations should they fall ill again. The same lady with the diarrhoea and vomiting, if she now falls ill with similar symptoms, will feel the need to go to hospital when she could get better at home. I know people are going to say you can never be too careful, but in these cases I think you can.

Anyway, maybe that's something to ponder about over the weekend. I know I won't! But hopefully interesting nonetheless! Big game this weekend, Liverpool vs. Man Utd, the last chance to sustain hope for the rest of the season. I think if Liverpool lose and fall 11 points behind, I'll stop following them with the same level of interest at least in the Premiership, which should please my wife! With that, I sign off for the weekend.

Take care all,
Thoughts just flow, when do they have to make sense?