Consultation in Primary Care

During my primary care visit, I came across a consultation with a middle age lady who is having a prolonged nickel intolerance problem. I found that her case is quite interesting as there are many important and remarkable issues arising during the consultation.  
      The lady is diagnosed with nickel intolerance in late 1990s after she had a sterilization surgery. After the surgery, she was having bad complication of gall stone and spleen problem. She also was feeling extremely tired and weak. Then, she suspected something was not fine and after a few test, she found that she is actually having nickel intolerance and need to undergo another operation to remove the sterilization clip which is made from nickel. Prior to the incident, her nickel intolerance problem starts to get worse. She underwent another surgery to remove nickel trace from her teeth and her body. Lately, she is complaining about her painful liver.
      I learned new things about taking patient history from the GP today. During the consultation, Dr X focused more on patient social history. Based on this case, I discover the importance of taking social history which includes patient lifestyle as well as patient occupation. Patient social history can somehow help the GP to find other underlying causes when making diagnosis about the patient’s health problem. In the case of this lady, Dr X suspected that she is having occupational liver damage due to nickel intolerance.  

      Her case is quite interesting because her health condition is somehow related to her previous occupation as a dental nurse as well as her lifestyle as a former Miss Brighton. As a dental nurse in the past, she had being exposed much to nickel appliances used in dental practice which can also become a possible underlying cause to her current health problem. From this experience, I discover that GP should be aware of the patient’s general appearance as well as their lifestyle because this information can sometimes help...