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Essay, 4 pages (1000 words)

Consultation in primary care

During my primary care visit, I came across a consultation with a middle age lady who is having a prolonged nickel intolerance problem.

I found that her case is quite interesting as there are many important and remarkable issues arising during the consultation. The lady is diagnosed with nickel intolerance in late 1990s after she had a sterilization surgery. After the surgery, she was having bad complication of gall stone and spleen problem. She also was feeling extremely tired and weak. Then, she suspected something was not fine and after a few test, she found that she is actually having nickel intolerance and need to undergo another operation to remove the sterilization clip which is made from nickel. Prior to the incident, her nickel intolerance problem starts to get worse. She underwent another surgery to remove nickel trace from her teeth and her body. Lately, she is complaining about her painful liver.

I learned new things about taking patient history from the GP today. During the consultation, Dr X focused more on patient social history. Based on this case, I discover the importance of taking social history which includes patient lifestyle as well as patient occupation. Patient social history can somehow help the GP to find other underlying causes when making diagnosis about the patient??™s health problem.

In the case of this lady, Dr X suspected that she is having occupational liver damage due to nickel intolerance. Her case is quite interesting because her health condition is somehow related to her previous occupation as a dental nurse as well as her lifestyle as a former Miss Brighton. As a dental nurse in the past, she had being exposed much to nickel appliances used in dental practice which can also become a possible underlying cause to her current health problem. From this experience, I discover that GP should be aware of the patient??™s general appearance as well as their lifestyle because this information can sometimes help them to make further diagnosis on their patient problem. Based on my observation on the lady??™s general appearance, she looks quite glamourous, wearing makeup as well as jewellery. Based on my reading, I discover that nickel is widely used in cosmetic product as well as jewellery. This somehow makes me understand about her condition better.

Apart from that, I also noticed another interesting issue – I became aware that patient with some medical knowledge can be good or bad to deal with, depending on the doctor??™s attitude, and theirs. Based on my general observation, I found that the lady has very good knowledge about her own problem. When I had the opportunity to talk alone with her, I observed that she sometimes looks quite impatient and tend to blame the doctor because she thinks the doctor is working quite slowly. She said that in the past she needed to do everything by herself ??“ she claimed that she had to do her own research, contact other people with similar health problem and gathering as much as information so that she can convince the registrar to remove the sterilization clip .

I have a feeling that she is pushing the GP too much. This sometimes makes the GP feel quite uncomfortable especially when she is starting to become quite aggressive and demanding. As a medical student, I put no blame on both parties, the GP and the patient. I think I should understand that the patient is actually worried about her health problem and she always wants the best for herself. From the GP point of view, I do understand that with such limited time and considering her commitment to other patient as well, she has tried her best to satisfy and fulfil her patient??™s agenda with the limited resources she had.

Even though I think it??™s quite annoying when patient press on the doctor too much, however, she managed to show her professional attitude by preparing to listen to her patient. From this incident, I did learn that as a doctor, we should listen to our patient to show our respect rather than derision. I appreciate that it is quite challenging for a doctor to have a consultation with a knowledgeable patient because normally this type of patient will have a high expectation as well as high demand from the doctor. However from the positive side, this sort of knowledgeable patient can be a pleasure to work with because they often save GPs time and effort, help the GP in broadening their own knowledge and are generally appreciative of GPs input.

From my personal observation, I found that the lady played an active role during the consultation. She is taking her own initiative by asking the GP about further tests that she should take for her liver problem. She is having knowledge about her own problem, thus this helps her to understand the information given by the GP. When GP is giving her input, she seems very determined and interested to know further about it. Comparing my experience in my country where patient knowledge are quite low, I realised that having knowledgeable patient is good because they are concerned and are aware of their health problem, and willing to take their own initiative to improve their health state. This explains more about the concept of doctor patient partnership where doctor??™s role is to guide and suggest the best available treatment option rather than deciding everything for their patient.

Personally, I think that in the future, patients??™ level of knowledge will keep improving, making my career more challenging but at the same time, this will motivate me to work harder to consistently update my knowledge in medicine as well as my clinical skills. In a nutshell, I personally found that GP visits are very useful in assisting me with patient consultation. I realized that in the real world GP consultation are not as perfect as what I had learned during my theoretical class. It is more challenging and requires our wisdom to make sure the consultation is able to fulfill both patient and doctor agenda.

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