The Doctor Will See You Now [Non-Fiction]

Chapter 132: General Medicine

OPD.

A woman comes to follow-up for her rheumatoid arthritis. Her joints are fine and her blood tests fine. I call her in. The moment she sits down, before I could say anything, she says, "Doctor, I have things I need to tell you."

I could tell this was not going to be a 7-minute consultation.

"I've been getting these cramping central chest pains for a while and I've taken stomach medications from another doctor and it's getting worse."

OK, let's start with a thorough history taking first. When did these chest pains start?

"Oh, a while."

Great. Days? Weeks? Months?

"Oh, I don't know. A while."

Years?

"Oh, not that long."

Eventually, she says it's a few months. Great, question one down. Now I want to know about the frequency of these episodes and what she means by 'getting worse'.

"Oh, they vary [in frequency]."

OK, but give me an idea. A few times a week? Several times per day? Several times per minute?

"Oh, it's very variable."

Variable between how infrequent to how frequent?? Eventually, she says it's up to 5-6 times per day. Surprisingly she volunteers it lasts minutes per episode. Now, what does she mean by getting worse?

"It's just... worse!"

More frequent? More intense? Lasting longer?

"Just generally worse!"

It was a long consultation.