A very angry patient stormed past me on the corridor one day on his way out, ranting:
“That doctor must be crazy! I can’t believe this!”
He was referring to one of the youngest-and brightest-doctors in our unit.
I was curious, and quickly dashed after the patient to find out what the problem was.
“I came to hospital today because of my swollen legs and I wanted some medication to make the problem go away. This doctor of yours has already wasted five minutes of my precious time by asking me ridiculous questions! He wanted to know when my leg swelling began; if it began suddenly or not; whether it hurt or not. The silly doctor even wanted to know if one of my legs had swollen first before the other! Can you imagine?!”
I could see what the problem here was, and I quickly but cautiously explained (the man was almost twice my size...!):
“I really get your point, Sir. Apologies for the inconvenience. But you see, that “silly doctor” has just asked you some life-saving questions.”
“How do you mean?” he asked, now more calm and attentive.
“Well, Sir, we know that even one symptom can be caused by several different illnesses. Headaches for example, can happen because of an empty stomach, emotional stress, many types of infections, or even in some cases, brain cancer! It would be foolish to simply give pain killers to everyone with a headache!”
Aha! Now my patient was focussed…
“There are many causes of leg swelling” I continued:
“Old folks can develop swollen legs due to immobility-sitting or standing for hours without taking a stroll or at least some leg exercise. And on the other hand, leg swelling can develop as a symptom or sign of some sinister underlying disease: it could happen in liver disease, kidney disease and rather commonly, in heart disease.
Malnutrition with very poor protein intake can cause leg swelling, and this is especially common among children in poor communities and war-torn regions. Filariasis is one of the parasitic infections that lead to leg swelling in some tropical countries like Nigeria. In this case, leg swelling may be unilateral (involving only one leg) although on rare occasions it may be bilateral. But one important cause of leg swelling, especially when it’s unilateral and painful, is called Deep Vein Thrombosis- or DVT for short. DVT can on rare occasions affect both legs and in any case is frequently fatal because it can have a deadly complication such as Pulmonary Embolism (P.E.). PULMONARY EMBOLISM IS DEADLY!”
“Oooh, I see…!” sang the patient, with a Eureka look on his face. “So, the doctor was only trying to narrow down on what could be the cause of my leg swelling?”
“Exactly, Sir.” I answered, almost rolling my eyes. “Now, if you don’t mind, I’d like to take over and ask you a few more silly questions about your leg. Have you been coughing, Sir?”
“Yes, but only at night and it disturbs my sleep. I feel a bit better now that I prop myself up in bed with more pillows.”
“Do you find yourself getting more easily tired with smaller tasks these days, like climbing one flight of stairs?”
“Oh yes! Funny you should mention that, doctor.”
“Hmm…are you hypertensive, Sir?”
“Well, yes, doctor, but I was diagnosed eighteen years ago and I’ve felt fine since then! I stopped my blood pressure medications and doctor visits fifteen years ago…”
After a brief physical examination, I came to a conclusion: “I believe, Sir, that you now have a condition called Heart Failure. That’s one important cause of your swollen legs! We can start your treatment in earnest while we run just a few simple laboratory tests to make sure nothing else is wrong in there…”
Suddenly, as if just out of a trance, the patient got up and headed down the corridor, and into the other consulting room where my younger colleague was:
“Doctor, I just want to say a big Thank you for being so careful with me earlier. I really appreciate that. Have a nice day, Doc!” he boomed happily, gave him a firm handshake and quickly left. It was now the young doctor’s turn to be confused!
One of the things to expect when visiting your doctor for the first time, is…questions! Sometimes just a couple, and sometimes a whole lot of questions!
We almost killed a client years ago due to poor medical records! That may be a story for another day...
But please note this for now: a good doctor will ask questions. If your first-time doctor jumps right to treating you just twenty seconds after you meet, then that’s a RED FLAG! In that case, do consider shopping for another doctor who will at least listen to you!
Have a great week, friends. I trust you know that I love you!
Be patient. Be careful!