Instant Relief

Few things in primary care give patient and doctor mutual and instant gratification.

It’s been a while since I reduced a “nursemaids elbow” or a spontaneous shoulder dislocation other than my own, or a finger dislocation, but those all count.

I once wrote about curing deafness in a man with a movement disorder by flushing ear wax more or less on the run as he bobbed around the exam room. That was instantly rewarding and also both exhausting and exciting. Even more ordinary cases of cerumen impaction are rewarding to treat. I almost never let my medical assistants get the satisfaction, or the risk, associated with that procedure.

A few months ago a man came to my Saturday clinic with a plastic tip from his hearing aid lodged sideways deep inside his ear canal. With the help of my modern headlamp (I trained on the cartoonish forehead mirror ENT doctors used to sport) and a delicate long pair of forceps I was able to remove it and relieve the stranger’s suffering.

Often, I delight in asking a patient to make the shoulder movements that hurt them so much a few minutes earlier and now feeling no pain, confirming that my steroid-Xylocaine (Hurrah Sweden!) injection hit the right spot.

A few weeks ago I saw a patient for an unrelated problem, who had recently received a nerve block by a nurse practitioner to the minor occipital nerve. The patient had presented with severe pain on the side of her head and the shot gave instant relief. I had never heard of that injection, so I read up on it.

Wouldn’t you know it, the following week I saw a different woman with an excruciating pain on the left side of her head. The pain seemed to originate in the back of her head. She was tender on the scalp over her ear and even more so over the lesser occipital nerve. She agreed to an injection. It was instantly successful.

In medical school it was “see one, do one, teach one”. This time it was “read about it, then do it”. Now I’m ready to teach it, thanks to a clinician with fewer years of education, born well after I started medical school. I’ll happily learn from anyone who knows something I don’t.

1 Response to “Instant Relief”

  1. 1 Dan O'Clair September 14, 2018 at 5:19 pm

    Thank you for your vulnerability. It is refreshing to see those in healthcare who are not above learning new things. The current theme of “evidence-based” everything, needs the balance of anecdotal accounts. If it worked in one situation and we try it in another and it also works there, why not try it again? How many times must it work to be moved from anecdotal to evidence-based? Keep up the good work, and the sharing of your stories!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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