Thursday, 23 September 2010

Abdominal anxieties

A 22 year old woman came to see me with abdominal pain. The symptoms were vague and mild, but she was anxious and unhappy. She seemed slightly awkward, not quite knowing where to look and desperately wanting me to take her seriously.

Being the excellent doctor that I am... I proceeded to question her in detail about her symptoms. No change in bowel habit, no weight loss, no blood from any unusual places, no history of fever. Just some generalised bloating and cramping. In my doctor head I had already nailed the diagnosis (bit to early for that clearly, but let's be honest, we all do it...) and proceeded with my 'Irritable Bowel Syndrome chat'. I mentioned that we would have to do some basic investigations to be sure there was nothing else going on, but that I wasn't worried and nor should she be. Done and dusted, another satisfied customer… "Next!"

Yet here she was, back in my surgery as an 'extra' later that very same afternoon. Trying to put a brave face on the fact that she was delaying my cup of tea and biscuit, I welcomed her back into my room. Before she had barely had a chance to sit, the words came tumbling out; "I think I'm infertile."

Right - so where on earth had this come from? After a bit of careful cajoling she explained that one of her friends had had abdominal pains very similar to hers and was now struggling to conceive. She had therefore assumed that this too was her fate. Furthermore she had proof of the problem, having had unprotected sex on several occasions but not fallen pregnant (sexual health education eat your heart out).

So there I was, thinking that I had dealt with her problem effectively, yet I hadn't come close to understanding what she was actually concerned about. I had ordered completely the wrong set of tests for her and had she not been brave enough to come back to me I might never have known. It just goes to show how quickly you can forget that it is your patient's expectations and concerns that need to be dealt with, not just your own.

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