Despite the fact that medical care here is still public like the UK, there is a world of difference.
Yesterday I saw an elderly man with recently diagnosed depression. Amongst all the blood tests he had, he had an amylase requested on the form. He had no symptoms of pancreatitis. He had never had pancreatitis. He had no other indication for amylase being done (and I just googled it to check if there was something I was missing). It was just one of the many boxes that gets ticked.
The doctor told me that PSA is also done routinely on all elderly men that present with new psychiatric problems, regardless of whether they are symptomatic or not. The reason "I once had an elderly patient with newly diagnosed depression, and it turned out his PSA was through the roof."
That's as maybe. But even so, why make the diagnosis in an asymptomatic patient? I was always taught that elderly men are more likely to die with prostate cancer than from it. Is it really necessary to put someone through treatment with major surgery and radiotherapy if they may die sooner and more quickly of a massive heart attack?
The patients also get abdominal ultrasounds. I don't know if PSA is done regularly on UK psychiatric patients (maybe it is, if so, correct me) but I'm pretty sure abdominal ultrasounds aren't. His argument "We have the technology, we may as well use it."
Yes, sure. But to me this approach lacks elegance. It's like trying to get into your own house when you've lost your keys. You can get a locksmith to come over and pick the lock, using his judgement as to which key is most likely to fit, or you can hire a tank and drive it straight at the door. The choice is yours.
In lighter news, today I was in the One Dollar shop, talking to one of my fellow students and a girl walked past me, stopped and said "Are you from London?"
"Yes I am."
"Wow, that's so cool. I luuuuurve Coronation Street."
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4 comments:
you know, i can empathise with their approach. today i couldn't help but wonder why we should bother learning what murmurs sound like and where and how best to hear them in order to make a diagnosis when we could just send the patient for an echo. i mean most paients with a murmur would have one anyway...
But how do you know who to do the echo on if you haven't listened for murmurs first?
I blame the NHS for making us think about money all the time....
Not to deflect from the highbrow nature of this discussion...but how is it that within a few days of being anywhere you've already found the £1 shop? It's a skill....
:p x
Ah, I stand corrected.
Apparently pancreatic cancer is a classic cancer that can present with depression long before any other symptom.
There we go, you learn something new every day :-)
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