Saturday, 22 March 2008
Occupational Health - more second opinions - Glimpses of the Obvious
Occupational health is an unlikely place to make a diagnosis. On the other hand, there are a lot of people not working because they have not had proper treatment
I have seen two people recently who have been treated for the wrong diagnosis.
The first was a woman on a large number of painkillers, and had recently started antidepressants, for piercing chest pain. Every orifice had been penetrated by medical instruments. However what made her different, was her habit of drinking a cup of scalding tea every hour. Was there a connection between pouring near boiling liquid down your throat and severe pain? Almost certainly! We negotiated a deal - she would carry on drinking tea, but cool it down first.
The second had injured his finger. His work involved typing and the pain he still had, three months after the injury prevented him working. A quick examination showed that he had also injured his nerve. In the hand and fingers, tendon and nerve injuries often occur together - the nerves and tendons are close together. When I was a medical student, our teachers drilled us to look for a nerve injury where there is a tendon injury, and to look for a tendon injury, where there is a nerve injury. This young man had a partially severed nerve, that had not been treated, was causing severe pain, and making it impossible for him to do his job.
I probably see one case a month where poor medical treatment of minor injuries leads to a person losing their job. A woman who does not have an X-ray to check their fracture has healed, until the fracture has past the point of healing. Nowadays no one seems to get physiotherapy after a knee replacement. The result is that he cannot climb stairs, not because the operation was not a success but because no one showed him how to climb stairs after surgery.
These injuries and omissions are not audited. No one checks that a doctor has asked about hot tea drinking or that someone can climb stairs after a knee replacement. Yet they reflect the underlying quality of a service. The everyday touches that make up good care.
What is the remedy? Nothing short of personal vigilance. If it does not feel right, it probably is not. Learn to be your own doctor, and save up and get private medical care.
Private doctors tend to care more about their patients. Private patients are valuable, because they pay directly for their treatment. Private doctors depend on their reputations for referrals. State doctors do a job, with too few resources and as long as they get their targets, tick the bureaucratic boxes, no one is the wiser as to whether they include the everyday touches of good medical care.