Few things in primary care give patient and doctor mutual and instant gratification.
It’s been a while since I reduced a “nursemaid’s elbow” or a spontaneous shoulder dislocation other than my own, or a finger dislocation, but those all count.
I once wrote about curing deafness in a man with a movement disorder by flushing ear wax more or less on the run as he bobbed around the exam room. That was instantly rewarding and also both exhausting and exciting. Even more ordinary cases of cerumen impaction are rewarding to treat. I almost never let my medical assistants get the satisfaction, or the risk, associated with that procedure.
A few months ago a man came to my Saturday clinic with a plastic tip from his hearing aid lodged sideways deep inside his ear canal. With the help of my modern headlamp (I trained on the cartoonish forehead mirror ENT doctors used to sport) and a delicate long pair of forceps I was able to remove it and relieve the stranger’s suffering.
Often, I delight in asking a patient to make the shoulder movements that hurt them so much a few minutes earlier and now feeling no pain, confirming that my steroid-Xylocaine (hurrah Sweden!) injection hit the right spot.
A few weeks ago I saw a patient for an unrelated problem, who had recently received a nerve block by a nurse practitioner to the minor occipital nerve. The patient had presented with severe pain on the side of her head and the shot gave instant relief. I had never heard of that injection, so I read up on it.
Wouldn’t you know it, the following week I saw a different woman with an excruciating pain on the left side of her head. The pain seemed to originate in the back of her head. She was tender on the scalp over her ear and even more so over the lesser occipital nerve. She agreed to an injection. It was instantly successful.
In medical school, it was “see one, do one, teach one.” This time it was “read about it, then do it.” Now I’m ready to teach it, thanks to a clinician with fewer years of education, born well after I started medical school. I’ll happily learn from anyone who knows something I don’t.
“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.
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