Tuesday, April 11, 2006

Doctor as Patient I - Cardiology

Before launching into this first of many sorties into the travails of a cantankerous, cynical doctor in his adventures as a cantankerous, cynical patient...Dr Dork would like to make one thing clear.

Dr Dork has been getting a bit "touchy-feely" in his last post and comments.

Dr Dork would like to reiterate that he is still definitely a grumpy old bastard. 'Nuff said.


Dr Dork spent some time working as a junior doctor on cardiology wards and in Coronary Care Units. And in emergency departments. He finds this area of medicine a bit of a mystery still at times. The difficulty is not in diagnosing an acute cardiac event...rather in working out what the hell is going on if cardiac enzymes, ECGs et cetera are normal.

Even though it is not his area, his clinic is not particularly close to an emergency hospital, so Dr Dork not infrequently gets a patient presenting with chest pain as he is "the nearest doc" to quite a few.

Dr Dork knows all the protocols for managing the serious side of things; arrests, anaphylaxis and the like. These kind of things are drummed into us ad nauseaum, no matter what area we practice in. Even back when he was doing psychiatry, Dr Dork had to do "resuscitation training" every 6 months.

A growing problem is how the management has been affected by the increasingly litigious climate here in Oz. It is the most common reason general practitioners in Oz are sued. So, in response, pretty much every single patient with chest pain presenting anywhere except to a cardiologists practice is now referred immediately to hospital. With the attendant expense to both the patient and the beleaguered public hospitals.

Unless they just put on a new shirt without taking the pins out. Even then it's touch and go.

Nonetheless, as a patient...it is a frightening position to be in. Simply being male increases risk. As does the work of Chronos. Heart disease is the biggest killer in Western society, after all. Of both genders.

Dr Dork would like to share some of his experiences as a cardiology patient, that he was not quite so aware of when on the other side of the desk.

1. It is impossible to sleep when you are wearing an ambulatory blood pressure monitor. This is a machine that involves an inflatable cuff being worn around your upper arm, wired up to a small device worn at your waist. It inflates to a level sufficient to cut off arterial circulation in your arm. Every single hour. For at least 24 hours.

If your partner grabbed your upper arm and squeezed as hard as they could every single hour during the night, Dr Dork suspects this might qualify as grounds for justifiable homicide.

2. If you have symptoms of a cardiac arrhythmia and wear a 24 hour ECG (Holter) monitor, you are guaranteed to experience symptoms immediately before the monitor is connected...and soon after it is disconnected.

3.Fixomull is rather painful indeed when removed from the chest in large quantity. Especially if the patient is worried the ECG Holter Monitor leads it has been used to affix are a bit loose. And the patient then adds significantly larger quantities of Fixomull than had the ECG technician. Covering a nipple.

Dr Dork understands how Steve Carell felt.

1 comment:

Adrian said...

Yes, the Holter monitor phenomenon is an interesting, infuriating phenomenon.

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