Re: Sir Karl Popper, swans, and the general practitioner
Sir,
The unfortunate experience of Mr. Bergmans reminds me of the illness that my classmate (and a good friend of mine) suffered from when we were Year 2 medical students in Hong Kong, almost 40 years ago. A young man in his early twenties, my friend told me he had low back pain without any history of tramua. As the "second MB" exam was near, I jokingly asked him if his pain could be psychosomatic. He told me that it was severe, especially at night. For this he consulted a GP, who prescribed some pain killers without relief. After several weeks, he was admitted to our teaching hospital through A&E, for acute urinary retention. The urosurgeon (who was our teacher) investigated the urinary tract for obstruction, while ignoring his history of low back pain. Only after every investigation had turned negative was a myelogram performed, which showed a lymphoma (then known as 'reticulum cell sarcoma') that explained all the symptoms. He passed away shortly afterwards, despite chemotherapy given (and white cells that I and other classmates donated) in the best equipped teaching hospital in Hong Kong at that time.
I had no knowledge how his GP had investigated his condition, but the severity and persistence of pain should indicate something serious. Yet, the diagnosis (not even known to the GP) was delayed until urinary retention developed. The inability of the urogurgeon to link the back pain history to the urinary retention also pointed to a blind spot in the specialist's approach, that of focussing the investigation on the problem of his own specialty.
I find it unacceptable that the GP who treated Mr. Bergen did not even do a physical examination. How would the GP justify that he was suffering from the same old problem without assessing in the history whether the nature of the pain was different from his previous experience? At lwast the GP should do a physical examination to look for any possible causes. Was there evidence of trauma? Was there sciatica? There is no justification for jumping to the "common things first" diagnosis without obtaining the basic data from the patient - a thorough history and physical examination is a must.
Sincerely
TW Wong
Professor and Public Health Specialist
Competing interests:
No competing interests
06 February 2012
Tze Wai Wong
professor
School of Public Health and Primary Care, The Chinese University of Hong Kong
4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong
Rapid Response:
Re: Sir Karl Popper, swans, and the general practitioner
Sir,
The unfortunate experience of Mr. Bergmans reminds me of the illness that my classmate (and a good friend of mine) suffered from when we were Year 2 medical students in Hong Kong, almost 40 years ago. A young man in his early twenties, my friend told me he had low back pain without any history of tramua. As the "second MB" exam was near, I jokingly asked him if his pain could be psychosomatic. He told me that it was severe, especially at night. For this he consulted a GP, who prescribed some pain killers without relief. After several weeks, he was admitted to our teaching hospital through A&E, for acute urinary retention. The urosurgeon (who was our teacher) investigated the urinary tract for obstruction, while ignoring his history of low back pain. Only after every investigation had turned negative was a myelogram performed, which showed a lymphoma (then known as 'reticulum cell sarcoma') that explained all the symptoms. He passed away shortly afterwards, despite chemotherapy given (and white cells that I and other classmates donated) in the best equipped teaching hospital in Hong Kong at that time.
I had no knowledge how his GP had investigated his condition, but the severity and persistence of pain should indicate something serious. Yet, the diagnosis (not even known to the GP) was delayed until urinary retention developed. The inability of the urogurgeon to link the back pain history to the urinary retention also pointed to a blind spot in the specialist's approach, that of focussing the investigation on the problem of his own specialty.
I find it unacceptable that the GP who treated Mr. Bergen did not even do a physical examination. How would the GP justify that he was suffering from the same old problem without assessing in the history whether the nature of the pain was different from his previous experience? At lwast the GP should do a physical examination to look for any possible causes. Was there evidence of trauma? Was there sciatica? There is no justification for jumping to the "common things first" diagnosis without obtaining the basic data from the patient - a thorough history and physical examination is a must.
Sincerely
TW Wong
Professor and Public Health Specialist
Competing interests: No competing interests