{"id":33853,"date":"2015-04-08T16:41:09","date_gmt":"2015-04-08T15:41:09","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=33853"},"modified":"2015-04-08T16:41:43","modified_gmt":"2015-04-08T15:41:43","slug":"samir-dawlatly-what-if-en-aitchess-was-my-patient","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2015\/04\/08\/samir-dawlatly-what-if-en-aitchess-was-my-patient\/","title":{"rendered":"Samir Dawlatly: What if En Aitchess was my patient?"},"content":{"rendered":"

\"\"<\/a>\u201cEnfield Aitchess?\u201d I called to the waiting room.<\/p>\n

A 65\u00a0year old man shuffled towards me and shook my hand. He seemed slightly out of breath.<\/p>\n

\u201cMy name is Dr Dawlatly, please come in and take a seat, Mr Aitchess,\u201d I said as we entered my room.<\/p>\n

As he sat down he mumbled, \u201cMost people just call me \u2018En,\u2019 actually, doctor.\u201d<\/p>\n

\u201cOkay, En, what brings you here today?\u201d I asked.<\/p>\n

\u201cIt\u2019s these darn winters doctor. I just don\u2019t seem to be able to cope with them,\u201d he started.\u00a0I looked at him, encouraging him silently to continue.<\/p>\n

\u201cI seem to have some sort of functional deficit once the weather turns cold. Nothing seems to work properly, and I was wondering if you had some sort of diagnosis or treatment doctor?\u201d he asked, looking at me hopefully.<\/p>\n

\u201cI see. Tell me more about your symptoms?\u201d I probed.<\/p>\n

\u201cWell, you may have read about me in the papers. I always seem to be in the news. My ribs have been very sore from the kicking I have been getting from politicians of all shades. That makes breathing and functioning properly difficult enough.\u201d He paused.<\/p>\n

\u201cGo on . . . \u201d I said.<\/p>\n

\u201cWell, in the winter it seems as though my systems are just completely clogged up with plugs of human species that I just can\u2019t seem to cough up and get rid of, and when I do, I don\u2019t have anywhere to spit them out to as my hands are tied by budget constraints, so I swallow them back down into my systems.\u201d He seemed relieved to get this off his chest, even if he wasn\u2019t able to clear his chest in real life.<\/p>\n

\u201cAny other symptoms?\u201d I asked.<\/p>\n

\u201cI just feel tired all the time; I can\u2019t do what I used to be able to. I\u2019m not sure I would be able to cope with a real crisis if it came along. Oh, and when I breathe and talk I find that I am whining with every breath.\u201d He stopped for breath. I could hear a faint wheeze.<\/p>\n

\u201cWhining? Don\u2019t you mean wheezing?\u201d I clarified.<\/p>\n

\u201cMy passages are constricted and my body is not happy. Whining, wheezing, what\u2019s the difference, doctor?\u201d He looked at me with his deep blue eyes. \u201cWhat\u2019s wrong with me?\u201d<\/p>\n

\u201cI don\u2019t think this is as simple as being one diagnosis, Mr Aitchess. Sorry, En. Do you mind if I take a quick glance over your record?\u201d He nodded as I turned to my computer.<\/p>\n

I scrolled through his summary:
\nConceived in 1945, born 1948, adopted by the country . . .<\/em>
\n Chronic circulatory insufficiency<\/em>
\n Anaemia owing\u00a0to loss of red blooded workers<\/em>
\n Multiple ECT\u2014Election controlled treatments<\/em>
\n CABG\u2014Commonsense achievement bypass grafting<\/em><\/p>\n

I turned back towards the patient. \u201cAs I thought, there are multiple factors contributing to your symptoms, En. There is, I think, one thing that we might be missing. I think you have COPD. You have, after all, been looking after smokers all your life.\u201d<\/p>\n

\u201cCOPD? What does that stand for?\u201d asked Mr Aitchess.<\/p>\n

\u201cIt stands for \u2018Chronic Obstructive Patient Demand.\u2019\u201d<\/p>\n

\u201cHow can you be sure? And how much of my symptoms can be put down to it?\u201d he asked.<\/p>\n

\u201cThat\u2019s difficult. There are no definitive tests; all that is published is a series of case studies. To make matters worse, there is no agreement on what might be the best treatment. I think it is definitely contributing to your problems, but with everything else going on it is difficult to say exactly how much,\u201d I answered.<\/p>\n

\u201cSo, is there no hope then?\u201d<\/p>\n

\u201cWell, we can always try a trial of treatment; En equals one, you might say. Perhaps a transfusion of fresh blood, a breath of fresh air, or a more radical amputation or transplant of your major operating organs, but there is no saying what might happen. I imagine you will end up with a few more kicks and all of the procedures have possible complications.\u201d I paused again.<\/p>\n

\u201cWell, that doesn\u2019t sound good. Perhaps best to not rock the boat, eh? I suppose I shall just struggle on for the next few years and see what happens. Before I go, can I have some soothing platitudes to numb the pain from these bruised ribs?\u201d<\/p>\n

Samir Dawlatly<\/strong> is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly<\/a>.<\/em><\/p>\n

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cEnfield Aitchess?\u201d I called to the waiting room. A 65\u00a0year old man shuffled towards me and shook my hand. He seemed slightly out of breath. \u201cMy name is Dr Dawlatly, please come in and take a seat, Mr Aitchess,\u201d I said as we entered my room. As he sat down he mumbled, \u201cMost people just […]<\/p>\n

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