Australian Doctor 14th June Issue | Page 17

OPINION 17
ausdoc . com . au 14 JUNE 2024

OPINION 17

Insight

Tricky , my dear Watson

her late 60s came in complaining
diverticulitis , and when we looked
Three days later , she came in
sometimes it actually does ring
Dr Jordana Rockman GP in inner-city Melbourne .
of left iliac fossa pain .
It had come and gone over the week , but she had been having a particularly bad episode over the
up her most recent colonoscopy , there was mention of diverticular disease .
She was febrile and tender , and
to tell me I was right . It wasn ’ t the chilli .
I think many of us go into medicine under the illusion that things
true .
I left that day with a little spring in my step , remembering how much I liked clinical medicine .
preceding 24 hours .
I explained that I thought it was
are fairly black and white : diag-
It may have also been the fact
My wonderful day as a clinical detective .
“ I ’ m sure it ’ s the chilli I ate ,” she said , “ but I ’ ve never had this reaction before .”
It had all the hallmarks of
diverticulitis and we needed to exclude an abscess .
Reluctantly , she went to ED and was admitted for IV antibiotics .
nosis and treatment , problem and cure .
Years in general practice can shatter this somewhat , but
that I had done no mental health plans that day . Some details have been changed to protect patient privacy .

RECENTLY , I had a day where I actually felt like I was practising medicine . Not that day-to-day general practice isn ’ t medicine , it ’ s just
ICS / LABA / LAMA IN A pMDI 1
that the days are often filled
with scripts and mental health ,
and I ’ m actually taken aback
when I need to use my clinical
skills .
That day was a classic , in
fact . It felt like it could ’ ve been
the 1800s .
It started with a diagnosis
of gonorrhoea ( to be fair , the
patient ’ s history helped : her former
partner had called to give
her the bad news ), and after triple-checking
that I had the dose
right , I found myself administering
IM ceftriaxone , satisfied
that I had provided an exact
cure .
I had forgotten how much I liked diagnosis and treatment .
Shortly after this , a sevenyear-old
came in with her highly
anxious mum .
She had seen my colleague a
few days earlier , and a respiratory
swab had come back showing
she had parainfluenza virus .
Something in this history
didn ’ t quite fit .
After being unwell for eight
days , my patient had gone back
to school , developed a sore
throat , fevers and , a day or two
later , this weird rash .
As soon as I examined the
rash , a thought from the absolute
depths of my memory
flashed through my brain : sandpaper
rash , scarlet fever .
Surely not , I thought , but
the more I looked , the more it
resembled a picture I had seen
in John Murtagh ’ s General Practice
bible .
Her throat was red , her
glands were up and , despite forgetting
about looking for the
strawberry tongue , I took a swab
and treated for scarlet fever .
Sure enough , a few days
later , the swab came back group
A strep .
I was feeling strangely
excited . I had forgotten how
much I actually liked this idea of
diagnosis and treatment .
Then I got another chance .
Later that day , a woman in
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