One aspect of general practice that appeals to me is that you never know what's going to walk through the door next. One patient could just have a cut that requires suturing, the next patient could come in with four chronic conditions that require full reviews. Another aspect that appeals to me is the continuity of care. When a patient comes in with something that probably requires an operation, you refer them to the surgeon. When they come back later for a follow-up visit, you get to see the patient in recovery and check whether your clinical suspicion was right in the first place.
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Today a patient came in complaining of bumps on his back that had been there for years. One of them grew bigger and painful over the last week and he was concerned. After taking more history and examining the bumps, the big one being about three centimeters in diameter, I made the diagnosis of sebaceous abcess, or in layman's term, a giant inflamed zit. I called Dr. R. into the room and presented to him my findings. He agreed with my diagnosis and proceeded to explain to the patient that it was not anything bad and the best way was to leave it alone. Standing next to Dr. R., I asked, "In what situation would you decide to drain it?"
He looked at me, as if thinking "ooh, you're going to be sorry you asked." Then said, "We can do an incision and drainage now, do you want to do it?"
Not knowing what I was getting myself into, I said, "Sure!"
Up the patient went onto the procedure table. After I injecting the local anesthetic, Dr. R. explained to me, "Just use the scalpel to lance the abscess, but watch out, it could be under a lot of pressure and the collection of pus could come out with a lot of force." Handing me the scalpel, he said, "You'll know when you've lanced it. You'll smell it. If you need anything, just come get me in my room," then walked out to see the next patient.
I was left holding the scalpel thinking about the giant zit exploding in my face. Gingerly, I positioned myself to be out of the possible trajectory of the pending explosion, then pushed the scalpel down the center of the abscess. No explosion happened. I breathed a sigh of relieve and my nostrils were filled with the sour and acrid smell of pus. Yup, Dr. R. was right. For the next ten minutes, I poked and squeezed the abscess and wiped away the cheesy blood-tinged pus. Finally, having squeezed the last drop of pus from the abscess, I put the scalpel down. Dr. R. walked in, checked my handiwork, and said, "Good job, Tony." Now I knew why he had wanted to leave it alone and let it pop by itself. I asked an innocent question but got the answer the hard way.
Well, it was all part of the learning process. At least the patient felt better right away and did not have to deal with the pressure on his back anymore. Though next time I may want to do it in a place with better ventilation.
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Tonight's dinner: broiled mackerel in ginger marinade on Chinese cabbage and sweet potatoes.
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