A patient comes today with a series of vague symptoms including "feeling fainty", headaches and a pain in the back of one leg. With my 2 students watching I carry out a cursory examination and conclude there is nothing too much to worry about. After he has left, we discuss the patient, and one of them asks how I can be sure he hasn't got a pulmonary embolism. I finesse this issue with apparent calm, explaining that he doesn't demonstrate enough relevant features to ring my alarm bells, but inside I feel that horrible twist of fear deep in my entrails. Have I missed a PE? If so, the patient could die at any moment and he is only in his twenties. True, it is a long shot; his age is certainly on his side, but even so...
After dismissing the students at the end of surgery I do an unscheduled house call in order to examine him more carefully. True, a call in these circumstances is something more often confined to non-realistic TV series such as the execrable "Doctors", but they have undermined my self belief and I feel I must follow it up, However, the patient is not home when I call, so I must wait until Monday to find out whether he was admitted to hospital as a desperate emergency. At least I advised him to seek help immediately if there were any developments.
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