I recently heard of a man who started complaining of an incessant rushing in one of his ears. He complained to his general practitioner and continued to do so, but the doctor maintained that nothing was the matter.
A few weeks ago he called his wife, saying that something was wrong and he needs to go to the doctor. He returned to his GP, who took the wife to a separate room and told her that there was nothing wrong with her husband.
Despite this, they drove to the nearest hospital, where doctors concluded that he had suffered a stroke due to a leaking atriovenous malformation.
Even I, as a lowly third year, know that all possible causes for tinnitus must be excluded before naming it “essential”.
Similarly, I know a lady who has suffered chronic back pain for several years. She tested negative for Rheumatoid Factor and SLE and has not responded to any pain medication, not even Amitriptyline. Yet not once has she been sent for an MRI.
Again, a good doctor does not simply claim oh-my-goodness-inexplicable. Especially not if there are no good MRIs to support his opinion.
I have sometimes wondered if it is even worth it to study medicine if you do not plan on specialising. Then I realised that if your family physician is terrible, you really are screwed.
It is the GP that must detect that skin growth as abnormal, your fainting spells as pathological, your complaints as worrisome. The GP is actually what House M.D. essentially is: a diagnostician.
In the South African context, this is especially important. It is so sad for me when we see patients with heart failure and end-organ damage, or children who have used their asthma inhalers incorrectly for years, or a woman who was never tested for HIV and now presents with full-blown stage 4 AIDS.
Primary care physicians who their jobs properly also do a great service to the country: by referring the necessary cases, while preventing patients with a simple dry cough from running to a tertiary hospital.
Finally, I must add something which many doctors seem to discard once they graduate:
The general physician has the opportunity to treat the patient holistically. He or she sees the patient possibly before type 2 diabetes mellitus sets on, at a time when an unhealthy lifestyle has not yet given rise to an unhealthy body.
So I add my voice to that of my university: