MEDICAL NOTES.

Auckland Star, Volume LXI, Issue 217, 13 September 1930, Page 7 (Supplement)

MEDICAL NOTES.

UNCONSCIOUS HUMOUR.

ORAL A2TD WRITTEN OPINIONS

(By PEE.ITUS.)

There are few tests of medical knowledge so searching as are medic-1 certificates, or the filling of insurance forms, and few such sure exposures of medical ignorance. A contributor to the "Australian Medical Journal"' has collected a, number of more than questionable certificates, and some of these are given here for your amusement. A few of these require a smattering of medical terms to the reader for him to appreciate the "delightful nonsense' , perpetrated by. the unconsciously humorous writers. The following is a selection made from many medical certificates supplied by doctors to employees of a X.S.W. Railway Department. That the doctor is as apt as the patient to seek for a cause of his malady seems clear from examples: — "Neuritis of legs due to vibration of car." "Parotitis and orchitis due to infection and overstrain." "Kervous breakdown caused by straining-.' , "Rheumatic knee joint and sciatica due to a fall on the hip." "Chronic nephritis and acute intestinal colic caused by strain of lifting." "Muscular rheumatism of legs and shoulder caused by vibration of engine." "Ptomaine poisoning caused by the effectd. of the rigours of active service." (Eighteen months after repatriation.) Some refinements of diagnosis command our admiration, such as "visceral rheumatics," "elongated misentery," "fracture of thyroid cartilage,"' 'ruptured diaphragmatic fibres," "slight abdominal injury involving the ureter/' "'chill causing diaphragmitis" and "biliary neurasthenia, caused by irritative occupation." Other diagnoses are delightfully vague, such as "a bad nose," "a diseased back," "bad legs," "gastric | diarrhoea," "acute debility,"' "ulceration , of the foreleg" (from a country prae- i titioner), "pyoria and lassitude." The; next one teems perfectly straightforward: "I have examined Mr. N. thfe morning, and am of the opinion that he wants a holiday for a month." lir the next case the optimistic prognosis eeems to have been fully justified, as the patient lost only five days from work: "Mr. E. has been suffering from the effects of disarticulation of the articnlar processes of the cervical vertebrae and will be unable to. resume hie occupation for four (4) days at the earliest." When Doctors Differ. An Auckland gentleman was telling me of three visits paid by him to a local doctor and the three separate and definite .diagnoses given—one at each visit—all within the space of one month, and all for the same complaint, which eventually proved to be acute indigestion. First visit —serious heart disease; seconddiseased gall bladder; third—disordered pancreas. Five local doctors failed to find any one of the organs named other

than perfectly healthy and normal, when the greatly alarmed patient rushed round to one after another asking for a written opinion.

It is a good idea to ask your medical attendant to put his opinion in writing (the fee is not increased), and if he is reasonably sure of his case he will give it. Some men treat medical certificates as a joke. They need a holiday; they are prepared to pay a doctor for a certificate to secure the holiday; they may be seeking a job for which a certificate is necessary; they may wish to insure in a life office (nobody objects to defrauding a rich insurance company); and in any one of these circumstances the easy-going doctor scribbles out something and the man (must not call him a patient) gets his job, or his holiday, or his insurance, and is ever afterwards grateful. I believe it is gratitude more than his fee that the soft-hearted doctor is looking for.

I was once examining a young man for insurance, and from his heart came a noisy cardiac murmur of a purely functional and temporary character, I entered this in medical terms in the report, knowing that the doctor at the head office would, recognise the harmless character of the noise. I left the report upon mj desk, and the following evening the insurance agent entered my room whilst I was absent and perused the report. He jumped to the conclusion that his proponent had been turned down, and when I arrived said, "You are too bally conscientious for me, doctor; I shall not go on with this case, and I will never bring you another."' Xow, see what one loses by being scientifically accurate. The Doctor's Bad Luck. Upon another occasion a girl of twelve had a fit, and then half a. dozen in rapid succession. I was awaiting an opportunity to find a cause and give treatment (I knew well what the cause was not), when the father came to me and asked if the girl died could I give a certificate. Truthfully I replied, no, unless I really knew the cause, but that the girl would not die. Of that I was quite sure. Another doctor was called. ■ He came, by which time the girl had recovered, had revealed the cause, and had gone happily to sleep. She never had another attack and remained well for many years, but the family always thought I did not know my jo is.

To give a carelessly worded certificate is a slight upon those who ask for it. A great pathologist has said that eighty of a hundred death certificates are inaccurate, incorrect, or misleading. ''Heart failure" is less accurate or scientifically precise than "want of breath" or "nervous insufficiency"' or "worn out." There seems a general idea that "the patient is dead, nothing is of any use now, why fuss about the cause." and "it is merely a matter of form after all. but I must pot down something," and "not on any account must my certificate be too detailed."