As a result, I'm a consultant. Very few people refer themselves to a surgeon, so the aforementioned
Every now and then, however, something slips through, mistakes happen, calls are made . . . something happens that makes me wonder how certain doctors had the mental capacity to graduate from primary school, let alone medical school.
Charlie (not his real name™) was a very nice 18-year-old kid who was sent to me by his primary doctor due to right groin pain. He'd been having the pain for several days, localised to the right groin, and worse when he would bear down (read: poop). It seemed a fairly straightforward presentation, and his doctor felt it was likely a hernia (though I'm quite certain he never examined him for reasons that will become crystal clear later), so he sent him for a CT scan which confirmed a small left inguinal hernia.
Those of you who are reading carefully have already discovered the problem. What, you haven't found it yet? Stay with me. I'll get you there.
When Charlie came to see me, he was clearly in pain, clutching his right groin. I looked over the radiologist's reading of the CT scan ("small left inguinal hernia) as Charlie said "It hurts over here, Doc", pointing to his right groin.
Right groin. Left hernia.
I looked at the CT scan itself which definitely showed a left-sided hernia, and my Inner Pessimist started yelling at me. "He's at the wrong doctor, stupid!" Trying my best to ignore Inner Pessimist (though I suspected he was absolutely correct), I decided to do something silly: examine the patient.
Charlie pulled his pants down gingerly, taking care to avoid his scrotum. I did the usual Turn Your Head And Cough routine, and while there was definitely a hernia on the left (which was tiny and completely painless), there definitely was not one on the right. His right testicle, on the other hand, was exquisitely tender, mainly on the back side.
"I told you!" my Inner Pessimist started laughing.
"Are you sexually active?" I asked him. He turned sheepishly to his father before muttering "yes" under his breath. "More than one partner?" I continued. The beet red colour he turned and the silence that ensued was exactly the affirmative I expected.
I explained to him that his pain was not due to a hernia on the opposite side (heh), but rather to epididymitis, an infection of the epididymis which stores sperm and sits just behind the testicle. It's usually caused by chlamydia or gonorrhoea and is easily treated with a few doses of antibiotics. A 2-minute exam (and asking the right questions, of course) is all it would have taken his primary doctor to save Charlie a CT scan and an unnecessary trip to a general surgeon, who has no business diagnosing an infectious urological infection anyway. I sent Charlie back to his primary doctor to get the appropriate antibiotics.
If you think that's bad, it gets worse.
Two days later (while this little episode was still fresh in my mind but I hadn't yet had a chance to write it down for you fine people), I was called at 8 AM (at least it wasn't 2 AM) by one of the hospital's gynaecologists. I get these calls with some frequency, usually due to a pregnant woman with suspected gallstones or appendicitis or some kind of surgical misadventure in the operating theatre where they need help. Those can be very difficult cases to diagnose, and even more difficult to manage.
But not this time. I wish it had been something that simple. The conversation went a little something like this:
GYN: Hi, yeah, um, we have this lady here."
Me (under my breath): Well I hope you have a lady, because if you're seeing a man then something is askew in the universe.
GYN: What? Oh, well she has a big labial abscess and is in diabetic ketoacidosis."
Me: . . .
GYN: . . .
Me: I'm waiting for the punchline.
The woman was acutely and severely ill due to a raging infection in one of her Girl Parts. In case you forgot, I don't do Girl Parts. Fortunately for me there are specialists who manage these exact types of Girl Part Problems, namely gynaecologists. Which she was.
Hence my confusion.
It sounded like an isolated gynaecological problem (apart from the diabetic ketoacidosis, which is a medical problem that I also don't treat), so I waited for her to tell me what exactly I could do to help. She seemed entirely shocked that I expected her, a gynaecologist, to deal with a gynaecological problem. She expected me to do . . . something. However, being the conscientious bastard I am (and because I was already in the hospital seeing another patient), I went to see her to make sure they weren't missing anything.
And . . . they weren't. It was an isolated abscess involving the entire left labia majora, but nothing else. I went back and told the gynaecologist that this was a gynaecological problem and that she, a gynaecologist, should take care of it. Right now. Reluctantly, she agreed to do her job and took her to the operating theatre where she encountered and drained a large labial abscess (which everyone, including the janitor, I suspect) already knew about.
It shouldn't take a general surgeon to diagnose or manage these problems, just like my skills should not have been required to diagnose shingles. And just like I shouldn't expect a nephrologist to remind me how to take out a gall bladder. There are certain things that are easy to miss, difficult to diagnose, or complicated to treat, and I'm always happy to lend my expertise.
These two cases were none of those things.