Differential Diagnosis

<--- This is a picture of the Pollok Country Park O-Map used last Sunday at the STAG score event. A good run and very mild for the time of year. Finished sixth probably thanks to a little bit of local knowledge of the park! Next event is the Edinburgh street event at the end of January which will be a first for me.

It's a new year and I've made a new years resolution to restart writing the blog after about six months without a new post. It's taken a bit of time to adjust to work and life after uni but time now to get back involved.

2012 and Henry's back at Arsenal!

The major news affecting doctors at the moment is the re-structuring of pensions proposed by the government. All public sector workers are feeling the cuts and NHS staff are no exception. After the BMA balloted it's members this week about the possibility of strike action, it'll be interesting to see what develops over the forthcoming months, I know that we've not heard the end of this. The referendum on Scottish independence also hit the headlines today - what could that potentially mean for healthcare provision north of the border?

In the BMJ this week the article which caught my attention was the obituary to the legendary football player Socrates, who captained the Brazilian national football team and was known as 'The Doctor'. I'll admit I didn't know that Socrates was an orthopaedic surgeon in his part time while not playing football, and was renowned for turning up late for training in surgical scrubs having finished late in theatre. He held a medical degree and had already passed his residency exams when he finally decided to devote his time to football (the salary at the small professional club he first signed for was already reportedly ten times more than that of a local junior doctor). In the end it was too much booze that led to his downfall and he died of intestinal septic shock on the 4th December.

The MPS send me a monthly or bi-monthly email with occasional medico-legal cases of interest. Today's edition recounts the story of a young 20 year old girl who presented to her GP with headache and dizziness. She was treated for vestibuloneuritis but was bed-bound for several days with persistent vomiting. The GP was concerned about the patient becoming dehydrated due to vomiting but was reassured that the patient was passing good urine volumes. She had also developed excessive amounts of unquenchable thirst (polydipsia). When the patient was finally admitted to hospital, she was diagnosed with diabetic ketoacidosis (DKA) and was left with serious neurological impairment secondary to the delayed diagnosis. The GP practice had to settle the case for a large sum. They had missed DKA because they had been too focused on the diagnosis they had made. It goes to show the importance of considering a differential diagnosis, and considering alternative causes when patients don't respond to treatment as expected.