Wednesday, April 12, 2006

Grand Rounds

Grand Rounds are up at Anxiety, Addiction and Depression Treatments.

Well worth perusing, a broad selection of healthcare blogging, with a spotlight on mental health.

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 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.

Saturday, April 8, 2006

Lazarus, arise !

Dr Dork is back on the air.

Or the net. Or whatever the kids call it nowadays.

Many thanks to all well-wishers. Apologies for such a long absence. Dr Dork has been crook, to use the Oz vernacular.

Dr Dork considers himself still relatively young. His hair follicles might beg to differ.

Nonetheless, there has been a fair amount of illness in his life, especially in the last 5 years.

Some cardiological things. Some gastrointestinal things.

But most of all, the Black Dog


Some readers will have inferred this already, perhaps, from some of Dr Dorks previous posts.

This will be elaborated upon later. As an ongoing theme. In much detail. You have been warned.

Dr Dork has spent many hours, whilst squirming uncomfortably in the patient role, pondering the reasons he began a blog in the first place. He thinks there are a few.

1. Dr Dork is opinionated.

He holds the view that the world should be a more just and fair place than it currently is. According to Cognitive Behavioural Therapy (CBT) principles, he now understands that this is classified as the "fallacy of fairness". Whilst Dr Dork accepts every other cognitive distortion that Ellis et al propose, he's stuck on this one. Blogging alleviates a sense of injustice. Like any half decent medico, Dr Dork gets pissed off at things that impact negatively upon the health of the society in which he lives, and on his own patients.

Ventilation, in a nutshell.

2. Education.

Dr Dork knows that a lot of patients seek information over the internet. This can be beneficial, or can be dangerous. As a general principle, Dr Dork thinks it is fantastic when patients take responsibility for their illness and want to be well informed. It bodes well for outcomes. But there is a lot of biased misinformation out there. Dr Dork believes that medicine is art as well as science. But the art is in the communication and interaction with a great diversity of individuals, and in the finer, subtle aspects of diagnosis and care. The provision of treatment is essentially based on scientific principles. Dr Dork may be a squeaky little voice in the forest, but that won't stop him squeaking. This is better explained here.

3. Doctor as Patient.

The world as viewed by someone struggling with depression. Who has straddled both sides of the fence.

Dr Dork suspects this is, perhaps, the principle reason that drove him to blog, in light of the problems in the treatment and prevention of psychiatric/psychological illness in Oz.

Which become more evident when you've seen them from multiple perspectives.

This is also the reason he has been careful about anonymity and location, and shies away from discussing his own practice. Sadly, even amongst the medical profession, depression and other psychiatric illnesses remain highly stigmatised.

Dr Dork has previously spent several years working as a psychiatry registrar. He went about halfway down the path to becoming a fully fledged psychiatrist before realising that he was sublimating his own illness, and changed to a different area of medicine.

However, Dr Dork has learnt more about mental health issues as a patient and a carer for a family member than he ever did as a doctor treating psychiatric illness.

He has learnt more about medicine than in all his years of study and clinical practice.

In otherwords, the experience of Doctor as Patient...with a chronic, common, complex illness, with much morbidity, significant mortality, and no ready cure.

Dr Dorks own illness is a mix of biological and psychological factors. He has experiencd both aspects of depression as a consumer, a carer, and a curer.

Dr Dork will return to this topic soon.

Grand rounds will be up on Monday at Anxiety, Addiction and Depression Treatments.

Dr Dork is recuperating with relatives whom are computer bereft and apologises, in that he might take a few days between posts, and a few days to reply to comments or emails. Akin to Intueri and Dr Crippen, both of whom are highly recommended, Dr Dork attempts to respond to all comments. If you've taken the time to read Dr Dorks blathering opinions, your own justly deserves a response.

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