Today I have abruptly transformed myself (briefly) into someone who is not only heard, but listened to. I was in a consultation with my GP, and I’d seen the patient before and taken the history (in this case, a severe right-sided pain in the back spreading round the side that was so awful he went to A+E with a suspected heart attack). The A+E papers he brought with him showed he’d had a very low pulse rate, and when I checked it I found it was 44 beats per minute. He said he felt constantly fatigued. I reviewed his medication and saw he was on a few drugs – ramipril for high blood pressure, atenolol for the same reason, and lansoprazole, for reflux. I checked his blood pressure – 118/64. That’s pretty good, I told him, perhaps we should think about getting you off one of your medications – the atenolol. It can slow the heart down, which could well be the cause of your fatigue, and it means you have to take fewer pills every day.
It’s not like that’s a brand new occurrence. I’ve come up with management plans before, but always in the presence (and often at the prompting) of a doctor. This was different, though, in that I was so confident I was right that I mentioned this to the patient before we went in to see the GP.
I know what you’re thinking: ‘cocky students, dangerous to put false expectations, what if there’s a complication you’ve not thought of or a condition for which the atenolol is crucial you’ve not asked about?’ Fair enough to think that, but here’s the thing. I always think that, and today was no different. Difference today was, I was certain I was correct, and when the GP asked me what I thought we should do I didn’t dither or wonder or provide multiple options of limited feasibility – I just said ‘stop the atenolol.’
What’s weird is, usually when I’m in with the GP the patients will answer my questions but direct their answers at the authority – the GP herself. Today, with this one patient, it was the other way around – he spoke to me, even when the GP was asking questions, and I can think of only one reason: it’s because he trusted my knowledge, my confidence in it, and he understood my explanation.
And that’s a thrilling and terrifying thing to know.