In $clinic, coal face medicine.
This past year, medicine is often like a quiz show – BZZZZZ! acute intermittent porphyria, BZZZZZZ what is hypertrophic cardiomyopathy with outflow obstruction.
It’s filled with enzymes, cells, pathological flow charts, and algorithms. The cases exist on paper and we play guess the diagnosis, a la Gregory House.

The doctor leaves, casually tells him to come to see me.
My first patient.
He’s a man’s man. Proudly independent, worked on the land his whole life and still looks like he could take on a bear and win despite being on the other side of 70.
He’s come in complaining of burning on urination.
Score! We just did genitourinary, I follow the algorithm, urine MCS – E coli. treat with antibiotics and treat all UTI in male as suspicious, so take bloods.

His PSA comes back a few days later >20. I close the program. Re-open. Enormous.
Follow the algorithm
We do a DRE. Prostate is hard and lumpy, non tender
Crap.

The PBL case of Mr $prostate is real and is sitting in front of me. We tell him that its probably cancer. We start him on the road of specialists, biopsy and imaging.
He’s stoic, but there is no hiding the concern in his voice and his eyes.

We talked about it afterwards, the doctor is clearly fond of this man, and I had grown to like him over the short time I had known him – his generosity, his direct honesty, his good humour. And now for Christmas we set on him cancer.
He left thanking us warmly, if a little distracted, and strode away, a bit less invincible.

I think it’s easy to get lost in the game of medicine in these first few years. We have little to do with patients, and when we do we often compare who got the ‘coolest’ case. We idealise the super specialists – Charlie Teo, Chris O Brien. Pioneers, giants among men, fighting the impossible fight and winning. We scoff at our Doctor, Patient and Society subjects, giggle at the so-called ’empathy score’, and a good number of students openly deride GP’s professing $chosenSpecialty as superior. We rote learn the method of delivering bad news, regurgitating for examination purposes.
This was not exotic, it didn’t happen in a rarefied tertiary hospital, no machines went ping, there won’t be any books written on it, no superstar surgeons were involved and this story won’t compare to tales of heroism, of snatching patients from the brink of death.
But for me, it was a timely reminder that the cases I learn, the books I read, ultimately it becomes real, the flow charts end with a real person, with fears, concerns, families, loved ones and that I should never forget it.

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