Reviewing Rheumatology. Everytime I read about Rheumatic Fever, I am reminded of a patient I met during my community medicine rotation. R, a 10 year old boy presented with recurring fever, sore throat, joint pains and chorea. Clearly, a good generalist can recognize the illness by using Jones criteria. Unfortunately, because of the kakaibang galaw, the parents, went to the city to look for a neurologist, who ordered, cranial CT scan and EEG. Came back normal. They were then referred to orthopedics because of the joint pains. The doctor ordered MRI of the knees, turned out normal. They did not followup because at this point, they already spent over 20,000 pesos of tests, transportation and consults. They are farmers, who earned 3,500 a month, with 5 children. They were now in debt. Months later, they consulted a cardiologist becthe patient complained of palpitations. 2D echo was done, revealing Rheumatic Heart Disease. Eventually, the patient will have Congestive Heart Failure. All these could have been prevented by a very good Primary Care Physician, with a keen, clinical eye. Diagnosis would have been straightforward, requiring less than 500 pesos. Complications could havebeen prevented. Sadder still, the mother was a Brgy Health Worker.
Posted on: Fri, 11 Jul 2014 13:34:08 +0000
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