Posted by: Tony Copperfield5 April 2013
The day-to-day life of a GP being what it is, this column could go one of two ways. It might be a Joy of Medicine piece, because, just occasionally, my PHQ does creep below 20. Or it could be an angst-ridden howl of despair about general practice currently being as much fun as licking sandpaper, so better have the ECT paddles handy.
Anyway, it starts like this. I moonlight as an ‘Ask the doc’ in a newspaper. Recently, I received a letter from someone who wanted more information about the ‘slipping rib syndrome’ his GP had diagnosed. Ha. Nice one. I turned the scorn quotient down. After all, it’s in the job description of the agony doc, right between ‘Don’t laugh at men worried about penis size’ and ‘Find something constructive to say to fibromyalgics’: ‘Do not be contemptuous of diagnoses GPs have obviously made up’. It’s a proud tradition.
Slipping rib syndrome, though... I hadn’t laughed so much since a patient wrote: ‘My new GP says I have somatisation disorder, which I’m pleased about because other doctors told me it’s all in my mind – but what is somatisation disorder?’ But suddenly I had a low-wattage moment. I very dimly recalled that slipping rib syndrome might be a genuine condition.
So I checked it out. And bugger me, it is. Okay, it probably doesn’t really involve a rib slipping, and, yes, it’s probably just costochondritis, but stop being such a sodding killjoy.
The thing is, I instantly recognised two existing patients of mine who definitely have SRS (as we aficionados call it) – one who has required repeated tests for reassurance and another who has a nice and (I now realise) unnecessary cholecystectomy scar to go with her continuing pain.
Suddenly, I’m a man on a mission, desperate to diagnose my first de novo case. I’m looking out for any giveaway sign of distracted intercostal rubbing or chest wall grimacing. I even start proactively asking patients about SRS symptoms, which might seem odd when they present with an ingrowing toenail, but, heck, there are unmet rib-based needs out there.
Anyway, bingo! Yesterday, I finally had a case. Barn door. Classical symptoms. Confirmatory findings. Clear diagnosis and explanation given to patient. Yesssssssss!
It was like surfacing from under water and taking a massive gulp of fresh air. Ah yes, I remember! This is what medicine is all about! No box to tick. No dubious-value screening. No dumbass questionnaire. No medication review or opportunistic BP check or smear reminder or feedback request or referral battle or prescription switch or flu jab reminder or whatever. Just a clear case presented, a diagnosis made, a satisfied patient and a contented doctor.
A Joy of Medicine piece, then. Except that, next year, just wait, slipping rib syndrome will be in the QOF.
In which case, pass the paddles and stand well back.