Sunday, February 8, 2009

Warped vision -> Blindness -> Out Of My League

As I've mentioned before, at UBC we start working in a family practice clinic from day 1. In our first term, we spend the majority of our time in the clinic interviewing patients because we don't really know anything about medicine. In second term, which we are currently in, we begin learning the fundamentals of medicine and we begin to develop our diagnostic skills.

Since January, I've been seeing a variety of patients who have mostly had infections, sprained ankles, and needed vaccinations. Most of the patients have been fairly straight forward and I am already able to predict the course of action the doctor I am working with will take with these cases.

There are some cases that are a little bit tougher though. Last week, I saw a woman whose chart stated that she wanted to see the doctor because she was feeling dizzy. I was thinking I'd see her, do an interview, take her blood pressure, check her ears, and everything would move along smoothly. Instead, as soon as I start asking her about her presenting complaint, I find out she temporarily lost her vision. She was talking to a friend and all of a sudden her vision started to warp and then she went completely blind. A few minutes later her vision came back but it was cloudy. Then, she went to lie down, and the back of her head started to twitch. That may have been a coincidence, but it was interesting because your visual cortex is located in the rear portion of the brain. After the twitching, she made her way to the clinic and now she was feeling dizzy but her vision was fine. I just sat there thinking...she temporarily went blind, and she told the office assistant that she wanted to see the doctor for her dizziness?!

Her blood pressure was fine, a little low maybe, but nothing that would set off any red flags. The problems with her vision, and by "problem with her vision" I mean the disappearance of it, made me give her a vision acuity test. She said that she had glasses but only needed them for driving. I gave her the test and she had 20/20 vision in her left eye. Her right eye, however, was 20/100. That's pretty bad! Afterwards, surprise surprise, she told me that she wears her glasses to correct the vision in one of her eyes, but she wasn't sure which one. I'd put my money on it being the right eye ;)

Anyways, after all this...I had no idea what the cause of her symptoms could be. This one was completely out of my league. Apparently 5 months of medical school doesn't make you knowledgeable enough to be a doctor. All I could do was try to comfort her because she was understandably shaken up by the whole ordeal. I am fairly certain, however, that she should be wearing her glasses at all times. Relying on her left eye all the time will put excessive strain on it.

My preceptor wasn't sure what the diagnosis was either, so we decided to refer her to an opthamologist.

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