> When nothing else works, go to the patient?

After he spent the night in the walk, we heard stories of medical exhaustive, we supplied the results of the analysis as long as the sheets of the telegraph, and we played with pride, sheets and resonances, fighting the sleep, in the soft shimmer of the screen to x-rays.

Every so often, I had a question salient, “But the physical aspect as he was?” Sometimes it was obvious that the examination of the patient was the mostù hasty turn of the presentation of the case.

I Would like to share some situations that have occurred in the short space of a few days in my own medical practice, to demonstrate how the physical examination is in the list of those in danger of extinction. Ambassador does not bring punishment.

Situation 1

“I’m here for a second opinion than my mother, becauseé the last three times that we have gone from our cardiologist has touched it not even once” – complained concerned a daughter, next to a smiling mother geriatric – “How do you know that really happens if you do not ausculta?”

Situation 2

“The other day I went to the doctor. I was always a full examination. I have even discovered the prostate cancer a few years ago, but this doctor that was there the other day – was più the same dr. X”, – said a patient – ” He even said that I had to do a blood test now and then come back between four months and do the other analysis, but has not used the stethoscope and not seen for months. I don’t think there tornerò.”

Situation 3

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A patient’s blonde, beautiful and statuesque body comes to me, becauseé had a half faint. The blood pressure orthostatic was normal. The analyses were normal. The pressure Holter of another structure was benign. The cardiac exam was absolutely normal, but when I made to lay down on the bed, the abdomen was hard as a rock.  I Swear that, in that position, I thought that she was pregnant of nine months.

I asked her: “by chance, is she pregnant?”

“it Would be impossible to” – he answered – ” I made to close the tube.”

I put his arms around this gigantic tumor as he did a midwife to investigate the position of the fetus. “I believe I have an extensive abdominal tumor” – I said, and, of course, the magnetic resonance imaging showed a mass of 16 cm accompanied by multiple tumors which filled the whole abdomen.

But wait…. c’è the worst

it was a pain in the chest, a couple of weeks after having carried out a test to stress the preoperative from the results absolutely normal. Was out of the cityà and I told her to go to the local Emergency. I received a phone call from a health care provider non-medical[1], which at the time of the conversation (which I should have thought would occur after a visit to the doctor) gave me the idea of not knowing absolutely what it was.

I Explained patiently to the case, and I said,” Listen, take my phone number and tell anyone I want to see of me. The test stress was great, but would check the troponin and if she has pain in the act you may also need to take a look at the coronary arteries, becauseé è a patient pre-operatively. According to me, has sorrow, because of the abdomen very compressed[2].

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But wait…. c’è still worse

The next morning I received a call from an interior said to me: “The patient has this strange abdominal pain”, hesitating then as if you didn’t know how to find an explanation, to which I replied impatiently: “Sì, and if anyone, anyone who put a hand on the abdomen feel that he has a tumor as big as a watermelon, which expands from the pubic symphysis to the diaphragm. Probably compresses the vena cava if you are sitting, causing a half-fainting. The crushing of the bladder and makes sì that is to urinate every hour throughout the night and can notò più to have relations with her husband without experiencing intense pain. Maybe the va to examine the abdomen. It resterà hit you!” – And riagganciai.

I’m not an examiner perfect né a perfect doctor. None of us is. I’ve also found, in a second visit, the things that I had missed, type a carotid plaque, a noise-abdominal[3], or a murmur which I am sure were not there yesterday, but the point is this: If you do not ausculto, touch, or hear not hoped to discoverò never. Are alarmed, whyé these situations are always più often and the patients, because of this, they receive damages in più frequently.  doctors are busy.

The time restrictions are increased because of the changed general climate of the sanità, which invites you to get obtained more if you lose less time to visit a patient to get the più the visit to others. We rely more and moreù to medical personnel not doctor who has faced many years of practice in the technique of medical examination (attention! I’m not insulting anyone, I just say thereò that è the obvious and, at the same time, I recognize that some patients are examined, more scrupulously by certain non-doctors that the doctors and sometimes is the only visit they get).

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We are cardiologists, but also internists

is it right to examine the patient, find a melanoma, the diagnosing atypical pneumonia, indicate the surgical treatment for hallux valgus, removing a gall bladder, discover a tumor uretrovescicale,[4], which causes pain in the chest due to a complete obstruction of the urethra – these are real situations that have occurred in our study cardiology in the past few months.

Some operator, somewhere, in this blanket of wool frayed which is the medical care in american has to take the responsibilityà. Someone has to declare “is my job”, when a patient who has exhausted many of the roads presents us in a situation of desperate need. I think that the best approach is this: “If I find the cause, willò someone who willà”, and then, of course, to visit the patient.

Melissa Walton-Shirley

[1] Healthcare extender – I think it is a figure that we do not c’è – nursing – physiatrists – volunteers – social workers etc….

[2] Constipated, or congested. “Crowded” means “crowded.”

[3] Check the end

[4]Uretuvesciular – This all over the Internet has only used him!! – Perhaps è a dysgraphia

8 September 2013