Plan B

Low and behold you are reading the 50th post of this blog. Way back in September when I started the blog I never thought it would've lasted this long, and now I'm trying to find a way to keep it going after starting A&E in February. That's where the Guest Bloggers come in; you guys will have to blog more regularly! Half a century of blogs, sounds good doesn't it?

The blog that I keep going on about will inshallah be ready for Monday, so I guess the 50th blog, being a Friday, will unfortunately be a bit of a damp squib, yet more stuff about my work. As I've mentioned in the past the majority of my work in my GP surgery is pretty mundane. However, what never ceases to amaze me is the number of people who come with weird and wonderful symptoms and most of the time I have no clue what is going on, and that's because often nothing is going on.

Often these patients arrive with expectations of what they want from me. They want specific investigations or treatments. The problem lies in having to explain why I don't know what is wrong or what are the possible explanations for the problem. I call this Plan B. Plan A is the tried and tested path for all the usual conditions, a cough, cold, sore throat, headache etc. Plan B is employed when I don't know what is going on.

The list for Plan B is pretty extensive. You could almost call it Plan B-N. After Plan A has failed or is not suitable the range of possible treatments incorporated into Plan B include: arrange some investigations (including blood tests and X-rays), different medication (often painkillers), second opinions, alternative medicine (acupuncture, homeopathy), specialist referral and the best of all, do nothing.

Having these back-ups has proved to be vital when dealing with the weird and wonderful. For example, I saw a middle-aged lady with leg pain. Started at random, worse in the mornings and unable to walk on her left leg when it occurs. Being the classic Anglo-Saxon, she arrived having taken no painkillers for the pain and wanted something done. After examining her leg I couldn't find any cause for her pain, so obviously prescribed a course of painkillers (Plan A) and asked her to return if there's no improvement.

I saw her yesterday, with no change in her condition. The pain was still occurring at random and she still had difficulty walking. I still couldn't find any cause of her pain. This is when Plan B kicked in; I went through all the possibilities in my head and after discussion with the patient eventually settled on some investigations, an x-ray of the leg and some blood tests. Chances are I may never find the cause of her pain but at least it keeps the patient satisfied that something is being done.

The problem comes with getting too immersed into Plan B. Sometimes there's a limit as to how far you can go. It's no longer about what you could do, but what you should do. Therefore when all reasonable avenues have been explored there's no point to go further, sometimes a cause just won't be found. Medicine is not an exact science. When that happens, it's important to realise that and learn to let go. There is the risk that as doctors we feel the need to treat, treat, treat, eventually taking over the actual need of the patient. It becomes a case of serving the need of the doctor to treat the patient and not the other way around. It can become dangerous because it leads to unrealistic expectations from the patients.

So there you have it, my little spiel about Plan B. Often doctors don't have a clue and have many methods as backups to make sure something is done and they're not caught out! The next time you visit your GP with something unusual or random, please bear in mind that the doctor might not know any more than you and sometimes the cause may never be found at all!

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