I’d like to apologise for the long gap in posts, my workload suddenly trebled overnight as exams approached and in order to continue being a medical student and being able to post at all I thought I should probably try to pass… now they’re over though, I saw some really interesting patients in the run up to exams (we have no time for the uni to give us revision lectures, but plenty of time to do the junior doctors work for them..). Just to warn you, this post is House-heavy.. I make no apologies for that.
I clerked a patient in ED a couple of weeks ago, he (middle-aged bloke, definitely overweight, smokes 20 a day, he honestly reminded me of Peter Griffin) came in complaining of constricting central chest pain that had suddenly got worse, he’d had it for a while when it got cold or when he had to walk more than a couple of hundred yards.. as a postman, you can see how this might be problematic for him. His pain usually went away after about 10-15 minutes if he was resting, but this had gone on for more than 30 minutes and he was beginning to get really worried that he’d had a heart attack. The SHO I was shadowing agreed with me that it was barn door angina. This was made even more obvious when after a puff of GTN (helps reduce the strain on his heart) his pain pretty much disappeared. The bloke was admitted for some observations. As there were no beds in the Coronary Care Unit (CCU) and he wasn’t really that sick, he was sent to MAU (medical assessment unit) for an ECG and to be seen by a cardiologist. Great. Job done. Next patient.
Or so you’d think.
About an hour after he was admitted the MAU consultant (an endocrinologist.. an absolute tosser as well) phones the ED and asks to see the SHO who admitted our angina case. This isn’t unusual, the hospital I was in at the time is not famed for its organisation, miscommunications occurred quite frequently and usually just needed a quick 5 minute chat to clear up whatever was unclear. As I’d taken the history Ian (the SHO) told me to come with him, as I’d probably remember as much about the patient as he did. Expecting a few quick questions about the history we went over to MAU and found the consultant. Before I go on.. I need to make it clear that my dislike of this man is rather intense. Partly stemming from this, and partly from his attitude towards anyone junior to him. The way he treats his juniors and medical students is disgusting, but his chauvinistic and degrading treatment of nurses and HCAs evokes thoughts of a plantation slaver, he really is that bad. I am praying that I am never officially assigned to his tuition as I’m pretty sure it will end with me suggesting that he takes a long walk off a short cliff, though I might not be as polite.
“Why is this man on my ward?”
Never a good start. For one, there’s 2 other consultants on MAU, both more senior (and better doctors) than this prick. Ian explained that CCU was full and he felt that the patient needed further observations before being sent home and as it was a medical problem.. the MAU had seemed a logical choice.
Dr Bellend gave us one of those weird smiles that you just know means “I know something you don’t know.”
“Gentlemen” (This is probably the nicest thing he’s ever said to a junior). “This man does not have a medical problem. He has a financial problem.” This confused both of us. “This man does not have angina. This man merely wants medical retirement.” He went on to explain (in actually quite a calm and almost professional manner) that our patient had presented to A&E via his GP on about 4 or 5 occasions in the last 18 months with various complaints that he hoped would lead to him being allowed to take medical retirement. He managed to trick the computer system by spelling his surname slightly different every time he presented, so as to not appear in the system (and therefore allow us to see any recent hospital episodes in the trust). Every time he presented with a textbook case of whatever condition he was attempting to portray, always managing to present just after the specialty rotation for the trainees, therefore virtually guaranteeing that he would see a different doctor each time.
I was genuinely impressed by this guys dedication and couldn’t help but think if he hated being a postman so much, he could surely have applied himself to getting a promotion or a cozy office job instead of coming up with these schemes to defraud the system.
Naturally I am quite a cynical person, but for some reason that seems to disappear when I’m talking to patients and I believe anything that comes out of their mouths. They could tell me anything and I would believe them. I spoke to my cousin (Med Reg in London) about this bloke and she just chuckled and told me that by the time I qualify, a patient could tell me that the white shirt I was wearing was white and that I wouldn’t believe them. Apparently I need to learn that patients are all deceptive, manipulative, evil entities that want nothing more than to sue me and take my license.
I guess House was right after all.