Liam Farrell: The despair of differential diagnoses

'But soft! What light through yonder window breaks? It is the east, and Juliet is the sun.'

If a firm diagnosis was perched invitingly on that balcony, we family doctors wouldn't need ruby lips, a heaving bosom, a wanton come-hither gaze and golden hair hanging down to be equally as ardent. It is our very heart's desire, our holy grail.

Once we have the diagnosis, management is a breeze, but all too often, we find the diagnosis is on a swallow's flight, fluttering far away from our despairing grasp.

With multiple conflicting, confusing symptoms raining down on me, rather than stick a fork in my eyeball out of sheer frustration, sometimes I try to zone out, stare at the spots on the wallpaper and try to count them, hoping that my subconscious will take a break from its obsession with sex and actually help out for once (there are 342 spots, by the way, 343 if you include the smudge caused by one of Joe's spectacular expectorations).

Unfortunately, 'I haven't the faintest clue what's wrong with you, but it's probably nothing serious and will get better on it's own, so be cool, baby,' doesn't count as a diagnosis. The Irish version, 'Feck it, sure it'll be grand,' is more elegant and succinct, and patients seem to find it reassuring; it's diagnosis and prognosis all in one, maybe it could be adopted more widely, perhaps even incorporated into the Liverpool Care Pathway.

Joe was a constant challenge. His symptoms were vague, never any coherent pattern, and would have left dear old Mr Harrison scratching his head.

Today was no different; a general 'uneasy' feeling that someone was following him, numbness here and there, and floaters which were apparently affecting his ability to enjoy online porn.

But I haven't been a GP for years without developing a certain low cunning. 'Have you ever had this before?' I asked.

'Yes,' he said helpfully, as precise as always, 'a few times, here and there, now and then.'

'Ah well,' I said, nodding my head sagely, 'You have it again so.'

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell.

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