I saw a pleasant man today. He was about my age and as he walked in the flash thought went through my mind that he looked somewhat parkinsonian. It wasn't a full thought but just one of those millisecond impressions that one gets from time to time. If I was to analyse it I guess it would be an impression of his slightly laboured waking with slight stooping of the shoulders.
As I always try to remember to do, I had quickly looked at his notes before I called him in. There were no ongoing health concerns and he hadn't been seen for over a couple of years, so there were no clues as to his reason for attending.
"I was at a folk festival a couple of weeks ago" was his opening gambit. No clear thoughts entered my mind. Had he had a fall, taken illicit drugs, had casual sex, or been close to a very loud speaker (all except the first very unlikely, this is folk not Glastonbury!).
"A guy came up to me in the interval and said that he had seen me earlier (I'd have been little unsettled at that point), and asked me if I knew that I had Parkinson's disease. He told me he was a GP and suggested that I see mine as soon as possible".
My patient was a little taken aback, not so much by the diagnosis as the rather precocious behaviour of the doctor. And I shared my patient's reaction. I really don't think it is up to me to casually approach members of the general public with what are known as 'spot' (nothing to do with the skin) diagnoses. I don't know the patient's context, I've no idea how much anxiety I might cause and I might be wrong!
The only situation I have decided in advance when I might approach a stranger and suggest a diagnosis would be if I was behind someone in a queue and noticed a likely malignant melanoma on the skin. I would justify this intrusion on the genuine likelihood that if the patient ignored the mole in question, it could literally be fatal. So in the case I really might be saving a life. That's hardly analogous to sharing a diagnosis that may not result in a treatment for some time and merely might induce anxiety and solve nothing.
Colleague keep quiet.
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