Word: tim
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...Patients like Tim might eventually tell you why they went to the doctor if you keep on asking long enough...
...Hold on Tim. Let's forget about all the tests and the other doctors. What happened to you? What hurts? When did it start...
...What Tim had, at least by his history, was a true classic - a common problem. His physical exam was also classic - tender at a certain spot on the inside of the calf, pain here when he tried to stand on tip toe. It's called "tennis leg" because it often happens on the tennis court; it feels like you just got hit with a ball. In the days before MRI we thought it was caused by rupture of an unimportant little muscle in the leg called the plantaris. Now we know it's actually a small tear of a part...
...problem at all if ignored? So the doc-in-the-box might not have know about tennis leg; they're not specialists, they're usually moonlighting docs in their fellowships - someone going into cardiology might know a lot about heart attacks but very little about muscle tears. Tim's subsequent referrals did make this innocence less likely. But it's hard to point the finger of blame...
...getting a Doppler, the test for the blood clots. I have seen patients with barely any calf pain at all fall over dead from the things - you can't be too careful. A recent scare about Vice President Dick Cheney's calf clots showed how seriously doctors take them. Tim was a little tender (albeit at just one spot) and this is - vaguely - a sign of clots. The test is non-invasive. And Tim was the nervous type. Scared patients can get doctors scared...