By Dr Peter Ntege
One day, this very eloquent and exotic looking patient walked into my consultation room, oozing pheromones of “class”. She sat down, like Meghan Markle ready for Oprah’s interview. I know nothing about fashion, but I could tell that her bag was neither bought from Pioneer Mall nor was it obtained from the overpriced Abryanz store. It was “Legit”! Anyway, unlike Oprah’s Meaghan, my Meghan gave minimal eye contact while we interacted, her iphone got the most of it.
She was chewing on gum when she walked in but courteously rolled it in a small shiny silver paper and damped it in the bin. She then wraps it all up when I asked for the reason of her visit and she said, “I have come to get a prescription for Carbimazole, I think I have Thyrotoxicosis”. If I was not a medical doctor that would have marked the peak of my fascination, however, as medical doctor I could only probe further, “Why do you think you have Thyrotoxicosis?” This turned out to be one of the longest consultations I have ever had, the patient was adamant about her diagnosis of Thyrotoxicosis while from my interaction with her it was an anxiety disorder with episodes of mild panic attacks.
Every medical doctor remembers the common dictum in medical school at the beginning of clinical years (Usually 3rd year or 4th year depending on the university), “Diseases do not read books”. The tutors in medical school recited this over and over again to emphasise to future doctors that, medical literature which describes signs and symptoms of diseases, patterns of progress, and treatment were not the binding representation of how the described diseases would always manifest.
“Diseases do not read books, always trust your clinical acumen.”
Clinical acumen is to a medical doctor what “gut feeling” is to a lay man, only that this type of “gut feeling” is steeped in knowledge, insight, and years of painstakingly gathered clinical experience. This clinical acumen allows for appropriate decision making even with insufficient or contradicting information. Clinical acumen is best demonstrated when a doctor decides to treat a patient for a condition based on the presenting signs and symptoms even when laboratory tests suggest the contrary but trusts his knowledge and experience with the disease.
During the Covid 19 pandemic, one of the biggest controversies has been, isolation and treatment of patients for Covid 19 even when their DNA PCR results are negative, because the DNA PCR test is not 100 per cent accurate. Luckily for Ugandan health workers, there were several lessons drawn from other countries which were hit by the Covid 19 pandemic much earlier. One the lessons was that some patients would show up at ER with negative DNA PCR results but with signs and symptoms of Covid-19 and their chest CT scan images looked very similar to chest CT images of confirmed (Positive DNA PCR) Covid 19 patients.
In this information era where google answers just about anything, clinical acumen is the most important concept that makes a doctor’s consultation relevant. One can read all medical books and learn about several medical conditions and treatment on the internet however, the books will not give the reader clinical acumen. Indeed, if diseases read the books written about them, they would be confused by how each one of them mimics the other in the way they affect humans. Unless guided by a doctor, the signs and symptoms of malaria will largely be the same as those of any systemic bacterial infection and viral infections. My Meghan Markle was convinced she had Thyrotoxicosis simply because when she googled her set of symptoms, it was the first diagnosis displayed, however all tests confirmed that she did not have Thyrotoxicosis but rather an anxiety disorder.
So, always remember this as you make assertions to your doctor about what you googled; “Diseases do not read books”
Dr Peter Ntege, MBchB, MPH Healthcare Management and Public health specialist