Thursday, 7 April 2011


Well, I passed the AMK.  Still dead centre in the middle of the satisfactory band.  I found whilst digging the other day that if I can pass everything with a satisfactory I should get a merit.  All excellent I think is a distinction, but I'm happy with a merit.  Not that I was planning on failing or borderlining anything that is.  I also passed the last SSU and the professional judgement that went with it.  This SSU is going well too.  Well, no, the essay isn't going anywhere at all but the attachment is going fantastically.  I'm seeing so many patients, getting the chance to see common and rare diseases, getting to examine, diagnose and offer a treatment plan.  I get to chat to them and take detailed histories, and answer questions fired at me from the consultants.

I had one event that put me in a bit of a professional quandary however, and I'm still not sure if I should say something, or if it's too late now.  My partner and I were sat taking a history from a patient on immunomodulators for his eczema.  He was pointing to and describing a crampy pain running in a thin band inside his right iliac fossa region which is just above your hip (Imagine your abdomen divided into a 3x3 grid with the top being a line across the the bottom of your ribs and the bottom being a line across your hips.  Right iliac fossa is lower right hand corner).  I had the patient's notes on my lap, where the consultant had requested an ultrasound scan of the right hypochondrium which is just below your rib cage and contains the liver and pancreas (right upper corner).  The consultant was worried about pancreatitis and so was running a blood test for amylase and ordering the ultrasound.  The only problem is that the pancreas is not where the patient was describing the pain, and it wan't the right sort of pain.  It's true pancreatitis pain radiates, but to the back, not down.  My partner flicked through his note book which just happened to have the last LSRC notes in it with the abdominal checkerboard drawn out which confirmed we were right.  The consultant had muddled his basic anatomy.  I should imagine he'd seen the area, incorrectly remembered it as being the right hypochondrium and recalled pain in this area could be pancreatitis.  Neither of us could summon the courage or work out the tactful way for two first year medical students kindly being allowed to interview his patient that he was wrong.  What would you do?  Whilst walking back to halls we placated ourselves with the hope the patient would say something when the jelly for the ultrasound was being put in the wrong place.  Since his creatinine kinase was up we wondered if he was experiencing death of one the transverse abdominal muscle bands (creatinine kinase goes up after a myocardial infarction as it is released by the dying muscle cells), but that really was us pushing our limited knowledge.

At my GP job I was marvelling at some old patient letters I was summarising.  When he was a young boy in the 1940's he'd contracted TB.  Upon discharge from hospital the Dr had written him up for extra milk, the way we would do now for any other drug.  It was fascinating.  I was also amazed at how long it took him to get over TB.  Knowing nothing about the disease in detail at all, he spent a year in hospital and was followed up every year for six years after that with the recommendation for extra milk and no PE.  Apart from trying to decipher the handwriting I love going through old notes.

Continuing the wistful happy vibe, if you like Mr Scruff, or are curious, I have The Voodoo Trombone Quartet on repeat on Spotify at the moment.  Hope you're enjoying the sunshine.

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