Tuesday, 24 April 2007

There's no point in asking, you'll get no reply

My consultant, Dr Fletcher, is an angry man. He stomps, he shouts, he swears, he makes sarky comments – basically, he’s got your classic Type A personality. He’s not exactly what you call the sensitive type when it comes to dealing with his juniors (with his patients, it’s a different story). I don’t mind this though. After working with him for some time now, I think his anger stems from frustration at the medical system and, unlike McBitch, I don’t think he’s a vindictive person.

Ward rounds happen twice a week and are opportunities for consultants to teach stuff to their juniors as well as treat their patients. What happens with Dr Fletcher is that he’ll ask me increasingly tough questions until the point that I either don’t know the answer or until I get it wrong. At this point, he’ll either have a go at me or make some sarcastic remark, depending on his mood.

Here’s an example from this morning.

“Tell me Michael, if you suspect that a patient has Wilson’s disease, how would you confirm the diagnosis?”

“You can look for Kayser-Fleischer rings – preferably with a slit lamp”

“So you do this and you can’t see any Kayser-Fleischer rings. Does that rule out Wilson’s disease?”



“I’d order serum copper and caeruloplasmin levels”

“You do this and the tests come back normal. Have you ruled out Wilson’s disease?”


“So will you just answer my question. How do you diagnose Wilson’s disease?”

I’m struggling

“Erm… a liver biopsy?”

“A liver biopsy? This is what you’d do next? And what would you be looking for on your liver biopsy?”

“I don’t know”

“So you’re telling me that you’d subject your patient to a procedure with a risk of pain and complications and you don’t even know what you’re looking for?* So what are you going to do – just order the test and hope that the pathologist knows more medicine than you? Is the how you practice medicine?”


“I’m telling you that liver biopsy is not the way to diagnose Wilson’s disease.”

“I don’t know what else you’d do”

“It looks like SOMEONE has got a bit of studying to do don’t you think?”

This type of thing happens on every single ward round. The other SHO hates ward rounds and turns into a quivering wreck every Tuesday and Thursday morning.

*you’d look for dry copper weight

p.s - The answer he was looking for was 24hr urinary copper levels
p.p.s - Just in case you were wondering, the title of this post is the first line of "Pretty Vacant" by the Sex Pistols. I thought it was quite fitting!

1 comment:

Anonymous said...


You should quote this out of Robbin's pathologic basis of disease to that pretentious asshole.

" Serum copper levels are of no diagnostic value, since they may be low, normal, or elevated, depending on the stage of evolution of the disease"

Wouldn't that mean that renal excretion is not as useful as everything else you mentioned?

PS. Thanks for blogging about this..for some reason this story will help me to remember this disease.