Thursday, November 25, 2010

Tables turned

I saw this patient who complained of heartburn. I gave her standard treatment and told her that if she did not respond, we would refer her for gastroscopy.

Months later I saw her again. This time she complained that the medication she was on was making her feel sick. She was very aggressive and accusative, as some patients get when they feel you are not giving them the right treatment. I checked and saw that it was metronidazole. Now, drinking alcohol while taking this particular antibiotic makes you feel dreadful, so I asked about alcohol consumption. She immediately denied it and became very defensive. I then asked about her heartburn. She said it wasn't getting any better. I asked about Grand-pa (a headache powder containing aspirin and caffeine) or aspirin use, as abuse of these can cause peptic ulcers. She had previously denied it. This time she paused for a while and then admitted to occasionally using Grand-pa. I starting explaining the link between Grand-pa use and ulcers. She then immediately backtracked and claimed it was actually paracetomol she was using.

I told her that we should refer her for gastroscopy and started explaining what it was. At this point she interrupted me and said that she had already had this procedure done. Oh, ok, I thought. I asked what they had found. "They found that I have ulcers" she said. Great, I thought, a diagnosis! "I'm taking tablets", she continued. I sighed on the inside. Usually at about this point my heart sinks because people who start with the statement "I'm taking tablets" often don't know what these tablets are. We usually become entangled in a complicated web of descriptions of size, colour, frequency, shape and formulation. For example: I take half of a small white diamond shaped tablet in the morning, two large round yellow tablets in the morning and at night; and a large blue and white capsule at night. This usually doesn't help me at all because, firstly, I'm not a pharmacist and, secondly, you get alot of small white tablets and alot of large yellow tablets.

"Do you know the name of the medicine?" I asked. "No" she said, as expected. "Actually, it is the same colour as your pen" she exclaimed. I looked at it. Coincidentally, it was a Nexium pen given to me by a drug rep. I turned it around to expose the label. "Is this the tablet you're taking?" I asked, showing her the label. "Yes" she declared happily. "But this is a treatment for ulcers" I said surprised. "Are you sure you aren't drinking Grand-pa?" I asked, knowing that this is probably why the Nexium wasn't working. She went quiet and I knew.

"You should stop drinking the Grand-pa and you'll get better I said". She smiled a sheepish smile and said "ok".