Filler Patients who make my practice

Known by name

BMJ 1998; 316 doi: (Published 13 June 1998) Cite this as: BMJ 1998;316:1801
  1. Frances J Dryburgh, consultant biochemist
  1. Glasgow

    I had not met her before, but I have known her name for 25 years: Patricia Patterson. She had hypoparathyroidism since thyroidectomy when she was 21 years old and over the years, on treatment with vitamin D, had had episodes of hypocalcaemia and hypercalcaemia. This latest episode of hypercalcaemia was related to an uncommon conjunction of events, stopping hormone replacement therapy and continuing with vitamin D treatment at the dose prescribed for some years. We met at the mineral metabolism clinic. She gave a classic history of hypercalcaemia, nausea, occasional vomiting, severe constipation. She had had endoscopy in another hospital, which showed mild oesophagitis and a small hiatus hernia. Measuring the plasma calcium gave the answer.

    I am a clinical biochemist with an interest in calcium metabolism. Recurring names over the years jog our memories as we report, and their presentation in discussion groups and clinicopathological conferences brings more clinical effectiveness. We still continue to recognise our patients, for such they are. Each blood sample and request is a request for a consultation. Our medical scientific officers, because samples are analysed and numbered but not named in the interest of safety, cost effectiveness, and speed, see only numbers associated with specimens and not names. Those who came into the health service because of a wish to perform tasks for patients are now excellent analytical chemists but have lost a certain rapport with patients. It is not possible to associate the high calcium with a patient, so it matters just a little less. Many of the older ones see the job as having changed greatly and losing its attractiveness for them. In the interests of cost effectiveness, we now have to argue cogently for the need for consultant laboratory staff near the patient in the hospitals we serve. Are we the last generalists covering a wide range of patients but with a knowledge and enthusiasm to follow the interesting patient or finding?

    To return to the patient, she told me that her family has thyroid problems, a sister has also had a thyroidectomy her surname is McMenemy. “Oh,” I said, “not Grace McMenemy, didn't know you two were sisters.” Haven't met her either, but know her blood. (The names have been changed with the patients' permission.)

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