The Doctor Will See You Now [Non-Fiction]

Chapter 133: General Medicine

OPD.

A middle-aged woman comes to see us having had chest pain, referred one year ago. From the sounds of things, it's what we call "non-specific chest pain", meaning it's not related to her heart, lungs, or oesophagus. It's what we call "functional", meaning there's no actual organic disease we can find and it's very likely nothing much to worry about. But because she's waiting some further tests to round up all her investigations, we have to follow her up in the mean time.

This appointment only took five minutes out of the seven minute quota I got. It means I get more time for later cases if any of them turned out complicated (or if the patient gets lost on their way to my door, they get more walking time -- happens at least once per clinic session).

However, this woman, like many who have regular follow-up for this kind of problem, is exceedingly anxious and eats up a lot of my clinic time without the need for it.

Her LDL (bad cholesterol) is 3.1, a bit on the high side. I ask her if she wants to start a statin, telling her the indications and risks and side effects. She asks me some more questions about it. I answer as best as I can. She decides against it, wishing to cut down on heavy cholesterol foods first. That's fine. That was all we needed to talk about that day so I will see her again in six months' time, I say.

"But doctor," she interjects. "I've been having these frothy urine."

She had that issue last time, too. The last doctor ruled out proteinuria, a loss of protein in the urine, which is the main bad cause of frothy urine that requires action. Otherwise, most causes are due to peeing too hard (from a very full bladder) or dehydration causing concentrated urine. I tell her it's not proteinuria, so she should just drink plenty and not worry about it.

"But I have frothy urine," she repeats. Yes, I heard you the first time. I re-explain myself.

Seeming dissatisfied with my insistence it's nothing to be worried about, she then tells me her chest pain history all over again. Yes, it's all documented from her first attendance last year. Nothing has changed. It's still there. She doesn't warrant a detailed cardiac workup based on the history and findings thus far. I tell her we'll wait for the rest of the work-up she has already pending and there's nothing urgent to be done right now.

I tell her that's all the time we have for today. I'll see her in six months' time.

She gets up and turns around again. She asks me about her blood pressure. It's a little on the high side -- but everyone's blood pressure is highish when they come to clinic, partly due to the exercise prior to getting it checked and partly due to anxiety. I reassure her -- her home BP measurement is fine. She said so herself. I'm not worried.

"I'll see you in six months' time," I repeat myself. Seven minutes gone now. I still have to write up her appointment documentation.

She walks to the door. Then, she turns around and walks back.

"But doctor," she says.

"I don't have any more time for questions today," I say to her.

"Oh, OK." She pauses. "But I want to ask--"

She thrusts her blood pressure measurement sheet at me.

"My heart rate is 89."

"So...?" I'm tired at this point. There is still a huge crowd outside waiting to be seen.

"It's fast."

"89 is a normal heart rate."

She squints at me.

"89. Is. Normal." I repeat myself. "Please leave. I have to see the next patient."

She finally leaves.

By the time I finished typing up her notes, she had taken up over ten minutes.