COFM Home visit.

DSC_8589x, originally uploaded by oyclubsnap2.

pictured: Our patient explaining to colin her diet restrictions for her gout.

I have to admit im now a fervent supporter for COFM! The COFM visit really helped me to see just how much our care matters to the practical lives our patients.

As it turns out, Mdm X (our patient) had gouty arthritis and was on NSAIDs to suppress the pain. Following the classical story of over-ingestion due to excessive pain in her knees, she subsequently developed NSAID induced gastritis. She then presented to CGH complaining of dyspepsia as well as epigastric pain. Over in CGH, the diagnosis of gastritis was quickly made via a OGD and the patient was discharged, with the replacement of her indomethacin with panadol, a less potent NSAID.

This management raised various issues. Firstly, it ignored that fact that the patient was in great pain; panadol was emphatically quoted as "worthless" at relieving the pain by the patient. Without appropriate pain management, the patient would then be no better off - simply trading her knee pains for her gastric ones. Secondly, by just treating the symptomatic pain by pain relief, the management neglected to include softer options like muscular physio therapy to strengthen the quadriceps. Without real treatment to the knee pains, the issue of future NSAID overuse remains in question.

Lastly, Mdm X was also found to be slightly constipated during her visit to the hospital, as she was having poor intake due to the gastric pains, coupled to her new and unfamiliar surroundings, one can't help but to wonder if she was having a psychogenic constipation. As it were, she was discharged with a further prescription of lactulose for her constipation. Now, unsurprisingly so, shes developed abdominal pains and a "bloated gut." after her daily lactulose consumption. An entirely nosocomially induced illness.

Suddenly COFM and all its emphasis on "total patient care"seems so acutely presented. Its definitely a worthwhile and important component of our course becausing nothing in Kumar and Clark really prepares you for the gross reality of the situation when faced with the issues of patient disability and social handicap whilst on the "job."

i hate the way its being taught in NUS with its over-reliance on lectures and formal notes. It was refreshing to actually meet a patient on her own terms in her own residence too. We got to see first hand how her life was directly affected by our intervention.

as a subnote, it was pretty to cool to have a tutorial conducted by the patient and our prof, in cantonese(!), on a HDB living room floor whilst squatting/sitting like primary school kids. hehe.

medicine - new expriences everyday.