Sometimes they like to unravel it like a mystery, expecting me to be Sherlock Holmes; sometimes I get a factual account and am expected to comment on the brilliance or awfulness of colleagues. Like a Judge.
As a GP (Primary Care Doctor), no account is off limits, as I can't hide behind the useful excuse of "It's not my specialty". It's not like a cardiologist at a Dinner Party who is spared all the chat about everything else. At some functions people seem to queue up for the opportunity of a second opinion, or to regale me with their stories.
I take all this with equilibrium, muttering that some stuff is difficult to diagnose in the early stages, mildly tut-tutting at obvious mistakes, and enjoying the success of my colleagues.
One of the more difficult diagnoses to pick out early is Coeliac Disease. Especially when it starts in adulthood. The symptoms are vague and varied. Sometimes it is merely tiredness, or a bit of weight loss. The history is rarely straightforward, and there is little on examination. We rely on a high index of suspicion, and tests.
In the past we did not have any blood tests to help us, so often the condition was associated with long periods of niggly, nonspecific ill-health. Investigation involved swallowing a pod at the end of a long tube, waiting for it to alight in the first part of the small bowel (about 40 inches from the mouth) called the Jejunum. You would fire off this little pod by suction, and it would rest on the surface of the small bowel, suck a little bit in and clip it off. It frequently failed and had to be repeated.Oh, the days of the Crosby Capsule!
I'm sure that Coeliac disease was underdiagnosed. Now a simple blood test is excellent. But you still need to be thinking of it (like in early thyroid problems) and it isn't that common.
I had this story last night over a particularly excellent Bhuna Ghost in a lovely restaurant in the big city.
My friend had to suggest the diagnosis to his doctor, and was not impressed. I have that happen to me, and usually the suggested diagnoses are wildly wrong, but I always consider them.
It is foolish not to.
