Doctors First, Specialists Second

One morning, I pulled an empty chart from the rack on the examination room door: new patient, Ms. Judith Cornish, age forty-seven. I knocked twice and entered. “Good morning, I’m Dr. Shaw,” I flipped open the chart. “You are Ms. Cornish?” (I always used last names. It was formal, I know, but I preferred erring on the side of respect, not familiarity). I extended my hand. She sat, leaning forward in a chair, one very lean leg crossed over the other. “Good morning. Yes, I’m Judy,” she said in a husky voice. She shook my hand half-heartedly. In five seconds, I had processed a huge amount of diagnostic information: One, … Continue reading


A Pain in the Bottom

 Bottom:  “Ready.  Name what part I am for, and proceed.” A Mid-Summer Night’s Dream, I, ii. Abstract: Over a one-month period a 17-year-old male presented with severe recurrent rectal discomfort clinically diagnosed as proctitis with anal fissure.  Both episodes responded to a course of antibiotics and topical steroid ointments.  On clinical examination the degree of rectal mucositis corresponded to that of his anterior oral mucosa, apparent side effects of oral isotretinoin therapy.  A history of constipation may have contributed to the finding of anal fissure.  Several similar cases have been documented in the medical literature.  Clinicians would do well to consider the possibility of isotretinoin-induced proctitis in patients on oral … Continue reading


Listen to the Patient…

Notes from the Xanadu Clinic, Norfolk Island, South Pacific The patient is a 65 yo man with a one week history of intense lancinating pain in the right upper quadrant.  He was examined by his internist who suspected gall bladder disease and ordered an abdominal ultrasound.  It was negative, so an abdominal CT scan was scheduled.  Between the ultrasound and the CT scan the patient developed a rash on the abdomen and back.  He attributed it to one of the new drugs he was prescribed for his abdominal symptoms. I saw him today for elective surgery of a skin cancer.  I greeted him with “How are you today?” He answered, … Continue reading

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