Another road trip 8: diagnosing in public

I can write about things that I see

In public, where the viewing is free

The many, the few,

With no interview

It’s observation, that is the key.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Confidentiality applies to my patient population; it doesn’t have anything to do with what I can observe in public.

In 1977, when I was junior medical student, I went out for a walk with my first-year family practice resident roommate in Saginaw, Michigan.  We walked past a man with coarse features, a very broad nose and heavy jaw, and outlandishly heavy bones over his eyes.  “Acromegaly?” I asked after we’d past him, referring to a pituitary tumor that starts in adulthood, after the growth plates have fused.  He concurred.

I never stop being a doctor; Even before I had a license, I diagnosed based on observation.

A couple of months ago I sat next to a friend, waiting to get dismissed from jury duty.  I looked down at his right hand, and saw the muscles between the thumb and the forefinger twitching; the medical term, fasciculations, don’t care the evocative quality of “bag of worms.”  I asked if he had Parkinson’s.

Today, my skills kicked in full force at a social gathering.

The bug eyes of Grave’s disease are easy to spot.  The thyroid lump that some people have in the lower part of the front of the neck, goiter, sometimes goes with it.

I saw two cases of scoliosis.  In the crowd I spotted the moon face and “buffalo hump” (enlargement of the fat pad between the top of the back and the bottom of the neck) that signals Cushing’s, from too much steroids (whether made by the body or taken for other problems.)  I could diagnose autism in the young man who rocked and didn’t make any eye contact at all.  From one woman’s rolling gait I could tell she’d had a failed hip replacement.  Several of the elderly showed early osteoporosis.  Several men showed testosterone deficiency by their prematurely narrowed shoulders.

When a person looks at the floor, moves slowly, and dresses in muted colors, I don’t have to do an interview to diagnose depression.

An extraordinarily tall young woman with very long, thin fingers showed all the signs of Marfan’s syndrome; her male relative at 6’8” probably had the same problem, but I didn’t get a chance to see his hands.

I heard the whistle at the end of the cough that tells me that person has asthma.

When another person sneezed three times in a row, I didn’t even have to turn around to diagnose allergic rhinitis.


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