Posted by: Dr Richard Cook3 August 2016
'So what are you going to write about dad? Boring stuff like sore throats?'
You enter very murky medical waters
This was the reaction of my eldest child as she struggled to control her mirth at the news that I was going to write a blog for Pulse. I'm not sure whether she was referring more to her perceived view of the mundane nature of my job, or expressing her opinion on the likelihood of me being able to come up with anything vaguely interesting for the readers. I’ll let you judge for yourselves.
'Well, as a matter of fact Ermentrude,' (not her real name given the circumstances), 'the differential diagnosis of a boring sore throat is long and varied.' Three hours later, after an extended teaching session, I think she was beginning to regret her comments but was learning to appreciate the joys of growing up in a medical household, an experience to which neither of her GP parents had been exposed.
Like all of us, I have seen a lot of sore throats, and with due respect to Ermentrude, it is fair to say that many of them do not throw up a huge diagnostic conundrum. However, my stumbling block is often that assessing the pain experienced by patients can be a very difficult task as it appears to be so subjective, especially in the absence of any obvious physical cause. Add to this the huge impact it can have on an individual’s day to day life and you enter very murky medical waters.
For example, imagine waking up to the 'worst pain you’ve ever experienced', sufficiently bad to require an urgent appointment with your doctor and a good few days off work. Do you, like me, after a careful examination reveals apparent normality, sometimes find your mind wandering during the consultation and need to remind yourself to stay on track and keep matters in perspective? On occasions I get fleeting images of escaping Syrian refugees floating in the Mediterranean waiting to be rescued, or worse still, not making it to rescue at all. Now those people truly are waking up to pain, but they are not sitting in front of me needing my support and opinion.
We live and work in a very privileged environment which we should not forget (one of my partners reminds us that if you are brought up in the UK you have already won the lottery of life), but still we must always remember that our duty is to the patient we are attending.
So a boring sore throat then? Once we’ve excluded tonsillitis, quinsy, thrush, ulcerative pharyngitis, glandular fever, tonsillar carcinoma, Kawasaki, GORD, foreign bodies, dental abscess and uvular oedema, it should be pretty straightforward.
Of course it could be just a viral sore throat I suppose, but they can be pretty painful you know.
Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate