Paying attention

 By Dr. Jim Ferguson

One thing that really irks my wife is people who walk on the wrong side of the road. Folks, it’s dangerous to walk with your back to oncoming traffic. And it is especially dangerous for pedestrians when cars pass each other and have to choose between a head on collision or hitting a walker. A pedestrian watching oncoming traffic could at least assess the danger and jump into the bushes! I wonder if this is a problem of education or simply the dearth of common sense in our world today.

A doctor pays attention to any change in bodily parameters or functions. An example is a new cough, chest pain with exertion or blood in bowel movements. It remains a truism that common things happen most commonly, and a pain or a flutter is more often a false alarm than an impending Fred Sanford cardiac event. Most decisions in life should be based on probability rather than possibility, but again this demands paying attention and decisions based on common sense.

I have observed that people often ascribe new symptoms to old or previously diagnosed issues (Fergism). A classic example is new chest pain attributed to “heartburn” and chronic esophageal reflux. I have seen disastrous consequences from this oversight.

Older folks more commonly have relevant symptoms. As an example, chest pain in a twenty year old is less likely to be angina than in someone who is seventy. While it is possible to have artery blockages at twenty, it is more likely in someone who has lived long enough to accumulate “rust in their pipes.” Unfortunately, older folks sometimes delay evaluation because they don’t want to be sick or compare their own health to their peers which often is less robust than a younger person’s.

I find some aspects of medicine more interesting than others. This doesn’t mean some conditions are less worthy of my attention, I just like broccoli better than Brussels sprouts. Actually, I have never met a sprout I could stomach until a friend taught me the secret of roasting the tiny cabbages in such a way that the bitter thiocyanates are cooked out.

Diseases of the gastrointestinal tract just “don’t do it for me,” as Jerry Seinfeld’s date once said of his somewhat highbrow comedy. Nonetheless, gut symptoms are common in primary care so I have to man up and keep up to date.

Not a lot has changed with the condition known as irritable bowel syndrome (IBS). The lay term “spastic colon” is an apt description of the symptoms if not the physiology. The problem remains that medical science doesn’t know why people have this condition, and there is no specific test to confirm the diagnosis which is often made after other conditions have been excluded. In other words, applying Sherlock Holmes’ deductive logic, when all the usual suspects have been eliminated and only the butler is left, the butler did it.

In medical-ese, “IBS is a functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits” (referencing UpToDate). This disorder affects up to 15% of the population and is the “second highest cause of work absenteeism.” The so-called Rome diagnostic criteria are often used when evaluating patients with chronic abdominal pain who don’t have other alarming  symptoms such as bleeding, weight loss or night time diarrhea. IBS symptoms beginning after age fifty are also suspect as is the presence of iron deficient anemia or a family history of colon cancer.

The Focus is not the place to make a diagnosis of abdominal pain; this is the purview of your doctor. However, you should pay attention in this modern era of evaluations sometimes done by non physicians and where time constraints often lead to cursory examinations.

A visiting relative recently complained to me that her foot was swollen. She told me that she had just seen her new internist for a physical since her doctor of two decades had retired. It was obvious to me that both feet, ankles and lower legs were swollen. I asked if her doctor had noted swelling or examined the pulses in her feet. She described only a gentle squeeze of her legs by the young doctor which apparently sufficed to check the box on the electronic medical record. Folks, you must pay attention and make sure your concerns are addressed.

As I pen this essay, my family’s attention is on labor as my daughter “pushes” to bring new life into the world. I have delivered more than thirty babies, and it has been my observation that some people have what might be described as comparatively easy labor. Others undergo a more prolonged and difficult labor which aptly describes the mother’s efforts and that of the baby struggling to come into the world. We too often take for granted the birth process, where, when everything goes well, even an internist can “catch a baby.” Unfortunately, things can go bad in labor very quickly which is why I preach care by obstetrical doctors in hospital settings.

Though I come from a scientific background, paying attention and observation are not always the pathways to reality. In the 18th century, John Wesley founded Methodism. He was a product of the Age of Reason whose acme was the Enlightenment, predicated on observational truth and reason. However, Wesley recognized the need of balance and articulated what would come to be known as the Wesleyan Quadrilateral. Wesley recognized the truth of scripture (Bible) balanced by experience (observation), tradition and reason.

I am not a fundamentalist, a philosophy which arose in the late 1800s as a reaction to scholars who pointed out the inconsistencies in the Bible. Fundamentalism maintains the inerrancy of the Bible. I believe the writers of the Bible were inspired, but imperfect like me. But I also believe Biblical perspectives are more than just guidelines.

So, I pay attention, listen, study and contemplate the world around me and the Wisdom of the Ages. And I envision my conscience as the rudder of my ship, thankfully guided by The Spirit who interfaces with my essence in that non-anatomical space known as my soul.

 

Food for thought…

 

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