One of the skills that I had to work on in my early career but has come more natural with experience is listening – listening to what my patients are telling me and their description of their complaints – rather than start to work things out from what they say at first (which we all know is pretty accurate 98% of the time!).
I like to think that by working on improving my patient listening skills, I am also improving my practice. It can be hard on a busy clinic to spend a little longer eliciting as much information from them as possible, when you know there are more waiting to be seen the other side of your door. However, so often, I have found that patients have the strangest descriptions of their conditions, with often the more serious conditions having the wilder presentations.
An unfortunate example of this was a seemingly healthy teenager who was brought into me on a busy Saturday afternoon clinic as a last resort by her mother. She had been complaining of headaches for a number of months and her GP had dismissed it as stress and worry over her upcoming GCSEs. She left her mum in the waiting area, who had bumped into a friend and was catching up on holiday stories.
As I started to measure her acuity, she happened to remark that, yes, she could see the letters, but there was always a spot just over it that was in the way. I immediately assumed she meant a floater and asked her to move her eyes around.
However, she insisted it was still present which prompted me to examine the fundi prior to subjective refraction, which is usually my routine. Sure enough, it revealed extensive papilloedema in both eyes, with haemorrhages extending into the macula area in one, where there was a haemorrhage just inferior to the fovea, hence her visual ‘spot.’ An urgent hospital referral followed which sadly revealed a brain tumour.
This was a few years ago but I often think about her.
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