General practice might not be an exact science – but it is still vital

General practice isn’t an exact science.

Identifying an illness is often a mix of knowledge, experience, guesswork – and time.

Recently a patient had a set of symptoms which defied diagnosis for several months.

She had been tired to begin with, but this is a common symptom.

She lost a bit of weight and had occasional fever and headaches, as well as mouth ulcers.

Again, it didn’t point to any one condition in particular, but at this stage I organised more blood tests which pointed towards lupus.

Antibodies were detected that are present in people who have that particular autoimmune condition.

So we sent her to the rheumatology unit at hospital – but a consultant thought, on balance, it wasn’t lupus.

To complicate things, people who test positive for those antibodies I mentioned quite often don’t have lupus – and he reckoned my patient fell into this group.

We went back to the drawing board but, following further tests, a different doctor finally confirmed that my patient did indeed have lupus.

Are you beginning to understand when I say it’s not an exact science?

My patient was a bit baffled at our collective confusion over her diagnosis, and I don’t really blame her – but her condition really is one of those tricky ones and she didn’t have the red rash over her cheeks and nose which is one of the classic lupus signs.

Originally I told my patient to come back if anything changed, which she did.

Symptoms can change over time so as a GP I can use that time as a diagnostic tool.

This helped us point us towards the diagnosis – eventually.

But it’s not always possible to make a diagnosis straight away.

Many symptoms will get better themselves and you can’t possibly do every test for every possible diagnosis for every symptom.

And sometimes the tests don’t give you a definite answer anyway.

And with an ageing population who have increasingly complex health problems, getting to the right diagnosis can be even more difficult.

But for my patient, it was worth persevering.

And hopefully it demonstrates why although it’s not an exact science, general practice, for all its faults, remains vital.