With apologies to Sir William Osler. For it was he, who is an icon of medical education and a former Regius professor of medicine at Oxford, who coined the aphorism, 'listen to the patient, they are telling you the diagnosis'.
The aphorism is indeed incredibly useful and a reminder of just how important history taking is in the practice of medicine. With today's over reliance on high tech scanning and other tests, it is a reminder that the fundamental skill of carefully and actively listening to the patient tell their story, remains central to diagnosis.
But...patients can lead you astray. I saw this 30 year old chap yesterday. He told me that he had been doing some gardening the previous bank holiday weekend and had strained his upper back. I confess I wasn't hugely concerned and had a very cursory look at his mid-back and palpated the paraspinal muscles to elicit some tenderness. As I sat down to suggest anti-inflammatories, he pointed out just a couple of spots over his antero-lateral chest. All too slowly the penny dropped and I had a more thorough look at his back-and there they were, the tell tale clusters of papules of herpes zoster.
I couldn't believe that I had not noticed them during my first look at his upper back. But I was looking and not seeing. Already accepting his account of the explanation of his pain, and sadly not using my own judgement, I was composing a quick response whlst 'looking' and hoping to catch up in a busy clinic. Quite simply he lead me astray!
No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.
So my wee book, The Art of General Practice on soft skills for GPs is finally published today. The publishers bumpf on the back is mostly ...
Blimey am I that old? So 13th April 1978 I finally qualified as a doctor. It had been a long journey. My first inkling of wanting to be ...
As a doctor I've long be interested in what it is like to be on the other side of the desk. In other words, what is it like to be a pati...