We live in an age where there is too much information available online for patients to self-educate and there are too many specialties in medicine that often delays patients from knocking the right doors at the right time. But where are the family physicians and general practitioners who can give them the right answers and guide to the right doors.
It has been 9 months since I had an inframammary incision to correct the venous drainage in my heart. The wound healed very quickly, but the tightness and pain associated with the movement of my rib cage was something that never seemed to go away. During my first visit, 3 months post surgery, I shared my concerns with the doctor and again during my last visit 3 months back I raised the same issue. The cardiologist put a steth on my chest to hear my heart beat, performed an echo to check on the re-routed pulmonary vein but never bothered to address the issue of pain and stiffness. Cardiologist and surgeons both had the same answer; it takes time for the intercostal nerves to heal and inframammary incision is much better than median sternotomy. None of them could suggest a remedy other than prescribing painkillers and in short I had to live with the pain until it vanished on its own.
In the last few weeks the tightness around my left chest returned and I had pain along the ribs under my left armpit. One day last week, while at the gym I felt my ribs were shrinking and strangling my left lung and I felt lifting my left hand would tear my sutured skin and expose my lungs underneath. Was this pain from skeletal movements or was it a result of something going wrong inside the fist-sized four walled chamber called the heart? I had no clue and I didn’t want to visit another cardiologist. Where do I turn for help next? Who should I talk to?
I was tired visiting the doctor and asking the same questions again, so I decided to turn to google for help. I typed “Pain post inframammary incision” but didn’t see too many answers under this topic.
This is when I pinged my friend, a General Practitioner (GP) in UK. I laid down in my bed thinking I was an examination table and I narrated my pain areas as I inhaled, exhaled, moved my left arm up and down and I laid on my right side. Call it telemedicine or chat medicine, all I needed was someone to figure out what was causing the pain. I remembered enduring the same pain a week after surgery and suddenly after 9 months the pain seemed to have returned. I experienced pain only when the diaphragm and ribs moved to fill my lungs with fresh air. A few minutes later the GP said, “It looks more like muscular and skeletal pain” and a physiotherapist would be of more help in this case than a cardiologist. GP’s diagnosis of my issue seemed absolutely on the money and none of the cardiologist who I visited in the past even referred to it as muscular or skeletal pain. He simplified the terminology, the reason for the pain and prescribed to see a physiotherapist than visit a cardio surgeon or a cardiologist. He also advised me to consult a family physician/general practitioner before I went a physiotherapist or cardiologist. His words gave me the confidence and strength that none of my other doctors gave.
8 months ago when I mentioned about my GP friend in the UK to a cardiologist, he smirked and said, “GPs don’t have much work/case load and they make money by just examining and referring patients” and he made it sound as thought it was a compounder’s job and these guys were making free money. I was shocked and surprised how the medical fraternity viewed and under-valued the role of GPs and FPs in the society.
As specialist doctors, almost all of them are forced to rely on machines and recommend tests (hospitals are run like corporates and for profit) to pin point the problem and not on the art of clinical examination. While GPs and FPs are the only set who strongly rely on clinical examination, but with dwindling population of GPs and FPs the art of physical examination is almost coming to an extinct.
Before you head out to see a specialist or start your search on google, visit your family physician or general practitioner. Remember the art of physical examination is where medicine and remedy starts!
Here are a few must read articles on this topic.
http://www.npr.org/templates/story/story.php?storyId=129931999
http://www.nytimes.com/2010/10/12/health/12profile.html?pagewanted=all
http://www.huffingtonpost.com/donald-m-berwick-md/health-care-waste_b_1411281.html
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