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At the heart of general practice since 1960

The famous razor of Occam

Winner of the under-35s category in Pulse’s 2015 writing competition, Dr Ahmed Rashid

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Cambridge is a funny old place. When you walk along the winding, cobbled streets, a significant proportion of the faces you see are associated with the university in some way. From the students and researchers visiting from around the world to the kitchen and porter staff that help run the grand buildings, this vibrant community makes Cambridge a charming place to live and work.

As you might imagine, this population makes for some great experiences in the world of general practice and my training has exposed me to plenty of eccentric and extraordinary individuals.

One such encounter was with an eminent scientist who came to see me about what he described as a ‘rather embarrassing trouser complaint’.

I remember looking nervously through his records before calling him in. It was very early in my training and I was apprehensive about whether I’d have the necessary authority to manage a consultation with such a distinguished academic. Almost resigned to having to knock on my trainer’s door for help, I called the patient through.

It was clear he was not used to being a patient and would much rather have been back in his lab than sitting in front of a bushy-tailed junior doctor. His irritability became more understandable when he explained he was attending because of a genital rash. It transpired he’d tried a host of different treatments, conventional and alternative, containing all sorts of ingredient combinations (except anything with an antifungal agent).

 

Examination, unsurprisingly, revealed the classic red and scaly appearance of thrush. I wouldn’t need my trainer after all.

Thrush is boringly common and despite my inexperience, even I’d seen it a number of times by then. Yet, somehow, this consultation taught me a great deal.

As I explained the diagnosis and management in the least patronising way I could manage, I couldn’t help but feel enormously satisfied with my career choice. I was amazed (and still am) at how the GP consultation changes everything.

There couldn’t have been be a starker contrast between us. He was in his 60s, commanding and a revered expert in his field. I was in my 20s, nervy and woefully inexperienced. Yet I managed to win his confidence and help him through an intimate and distressing problem.

The case also highlighted how effective general practice is at applying a magic dose of common sense.

In his brilliant mind, this patient had considered numerous hypotheses and tried an array of solutions. I, on the other hand, decided the simplest solution was likely to be right, applying the famous razor of Occam. On this occasion, I hope the razor didn’t prove too sharp.

Dr Ahmed Rashid is a GP trainee and NIHR academic clinical fellow from Cambridge. He receives a £50 book voucher

<<< More from Pulse’s Writing Competition 2015

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Readers' comments (7)

  • Rub a dub dub.

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  • How did this win?

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  • Gosh, sorry the trolls seem to be out of their cages.

    This is just the sort of difficult consultation that young GPs have, (and in fact, when your patient is a GP of more senior years than you it is even more disconcerting).

    It's making two nice points - how common things are common in the real world and academics don't always realise what is common, and also the difficulty of feeling yourself to be the junior person socially/academically but needing to be the professional offering advice.

    A very nice piece, well done.

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  • Azeem Majeed

    A very well written article with a clear message. Congratulations Dr Rashid.

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  • I have fond memories of Cambridge.During consultations i spent more time talking about what these boffins did than actually discussing medicine.In comparison to their intellectual pursuits general practice was utterly boring and brain dead.I knew then I had made the wrong choice.

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  • Excellent.

    What occurs commonly, occurs commonly.

    The main problem with patients Googling their symptoms for differential diagnoses is that this fundamental statement is not used in the lists of possible diagnoses. If only this was applied to search results our job as a GP would be very much easier. GPs spend so much time reassuring patients that their rashers other symptom is not some rare condition and they do not need a referral to have the wisdom of a Consultant. Interestingly enough, half the time that we refer to Consultants the patients are seen by doctors with less experience than us anyhow.

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  • well written piece, well deserved winner

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