I am sure patients are getting more complex, or is it because I know things now that I didn’t know five years ago when I first started prescribing?
Recently, I saw a 54-year-old woman about her hypertension. She reported a two-week history of eye pain with a feeling of constant ocular pressure, headaches and temporal tenderness. I immediately thought this could be temporal arteritis and ordered an urgent blood test, which showed that her plasma viscosity and C-reactive protein levels were slightly raised. I discussed these results with my GP colleague, then with the on-call rheumatology registrar in the local acute hospital who suggested that I prescribe prednisolone 60mg in the morning for the patient and refer her promptly for an outpatient rheumatology appointment.
A few days later this patient underwent a temporal artery biopsy, which was negative (although, apparently, this does not rule out temporal arteritis completely). While taking the prednisolone, the patient’s headaches and eye pain subsided quite quickly. The dose was reduced gradually under supervision of the rheumatologist who said that the cause of her initial symptoms may never be known.
Working in general practice is interesting and every day is different.
I know it is a cliché, but there is never a day that goes by when I don’t learn something new. I believe that my diagnostic skills have improved significantly since my early days as a prescriber. When I first started prescribing I would frequently ask the doctors for a second opinion; now I am much more confident making diagnoses. Despite this, I do sometimes worry that I might be missing something — as one of the doctors has said to me: “You don’t know what you don’t know!”
What I do know is that I am very lucky to have such supportive GP colleagues who are happy to spend time discussing tricky or complex patients with me. This has enabled me to build on my knowledge and develop as a practitioner. In this environment, it is important not to work in isolation — the doctors and I have slightly different knowledge bases, which, when combined, can lead to the best outcomes for our patients.
