Family doctors work with undifferentiated disease, the grey zone of medicine, separating life-threatening illnesses from the less so. In medicine, we call it separating the zebras, the uncommon diagnoses, from the horses, the far more common diagnoses. To do that, your family doc not only has to know medicine, but also you and what is normal for you.
I spent one summer training with Dr. X in Summerside, PEI. He was a Jack-of-all-trades family doc — office practice, anesthesia, minor procedures, inpatient care and so on. His patients would speak of him with pride because he took the time to know them.
One day, a middle-aged man, otherwise healthy, booked an urgent appointment. His concern: headaches. As the medical student, I went in first, took a thorough history, did a physical exam, and then — the hard part — told Dr. X what I saw and what I wanted to do next.
Headaches are one of the top 10 reasons why someone sees their family doc. The vast majority of the time, headaches are managed with lifestyle changes and when needed, medications. Though they can have a major impact on a person’s life and function, rarely are headaches a sign of something life-threatening.
18 years of studying and practicing medicine, I’ve diagnosed that something serious twice.
The first time was that day in Summerside, PEI.
“Normally, we don’t order CT scans for a headache,” Dr. X said. “Why this time?”
The reason I wanted a CT of this man’s head was that the story didn’t fit. He was an avid cyclist, his physical exam was normal but for the past week, he kept falling off his bike.
Dr. X nodded, “I would also add. I’ve known this man since he was a kid. He never complains about minor issues. For him to come in, something is going on. For him not to be able to bike ride anymore is a serious problem.”
Turned out, the man had a brain tumour. We saved his life.
This story is important. For one, it shows how a family doctor’s job is to spot the one time a headache isn’t just a headache. For another, it really matters that your family doctor knows you. Knowing you takes years to happen and can change medical decision-making.
That kind of familiarity, that relationship, becomes even more challenging in a system as fragmented as ours. Think about it: when you’re worried about an illness, options include your family doc, a walk-in clinic, the emergency department, TeleHealth, a virtual doc and so on.
Of all those options, the only one who knows what’s normal for you is your family doctor.
Next time you’re weighing your options, consider saving your visit for your family doctor. Knowing you might just save your life.