Groote Schuur Hospital 'cures' me of congenital condition

I was a patient at a Groote Schuur Hospital's medical outpatient clinic from August 2018 to October 2019, visiting roughly every six months. In July 2018 its ER referred me there for further management of an acute medical condition.

At each visit I told the specialist – the professor head of department I saw the first and only time – and registrars I believed the condition was a symptom, an indication of something else that was going on. Like late 2017 when I attended the ER for acute vertigo following prolonged flu. They never diagnosed the underlying condition and discharged me. When it reoccurred over the following three months, I went to a private specialist who immediately diagnosed it and prescribed treatment (I haven’t had it since).  He said the flu had had a “cascade effect” and exacerbated the underlying problem. 

This time the condition, which presented from nowhere and was distressing, also coincidentally followed prolonged flu. 

Now, except in April when senior registrar Dr Viljoen (hipster glasses and skinny jeans) acknowledged me, the others – at each visit there were new ones in a unending stream – didn’t react or investigate what the underlying conditions might be. They are not TV’s sleuth doctor House who by deduction and discovery diagnosed obscure infections and diseases. (An anecdote a GSH practitioner told me a few months before was a hospital doctor diagnosed a patient's condition that had evaded his more experienced colleagues because he had seen similar on House.) They gave me the patronising impression like, what do I know.

They were thorough only in terms of their speciality. ECG, blood pressure, weight and a physical exam were done at each visit. There it stopped. Blood tests were ordered once in July 2018 at my ER visit and not again. In other words, they relied on key tests that were up to a year old and no longer relevant to diagnose possible conditions that continued in the present.

In April I was diagnosed with a dental lesion and infection in my jaw beneath a molar. By then it was four months since I first experienced the symptoms. Its genesis was in the same time frame as my medical condition. The infection showed significant pathology which had systemic implications; mouth and tooth infections usually do. (I went to another GSH outpatient clinic but they were unable to help despite it being a specialist hospital. See here.)

So in April at my follow-up visit, coincidentally a couple of weeks after the lesion was diagnosed, I showed the registrar Dr Mphisi the scan taken privately and a private practitioner’s referral letter. I suggested it might be the cause of the trouble.

Consulting Viljoen about my medical condition, he dismissed the new evidence as a mere “tooth ache”. To his credit Viljoen was receptive, listened to me and agreed it might be a symptom of my present problem. He instructed Mphisi to make a note of it in my record as a relevant factor who would not have done so otherwise. 

At my visit in October 2019 (my last which I didn’t know then) there were two fourth year medical students in the examining room. The doctor was a tall, rangy man. He had the features and name of an East African, Kenyan I thought. He was pleasant, more extrovert than the other doctors. 

I related my medical history as I did each time, the symptoms that brought me to the clinic, which by then were less frequent, and infection in jaw which had by then been attended to (not GSH) which I said may be the underlying reason for my present condition.

Dr “Kenya” examined me. Afterwards, looking over a test result, discussing it with the medical students (to whom he gave factoids about my existing conditions) but still seeming unsure, he abruptly said it’s okay; it’s normal. 

Then he dropped a bomb: I didn’t have the existing congenital condition (mine was benign but if serious, especially if infected, requires surgery) GSH had diagnosed years ago and related to my present condition. (I didn't think this defect was the cause of my present trouble but it had to be excluded.)  This was the first time I heard this including at my previous visits to the clinic over the past year and 15 years ago and when I went to a private specialist six years ago for a check-up. I declared it each time as part of my medical history and it was in my medical file.

“There’s nothing wrong with you”, he said. “You worry too much”. So that was it: worry.

Then he asked me when I would like to return to the clinic for a follow-up – six months? What? I thought and said: “If there’s nothing wrong with me, discharge me. I told your colleague [Mphisi] the same in April.” (Earlier I told Kenya I didn't want to be at the clinic. It was a drag as anyone who attends public healthcare facilities know.)

He hesitated, looking flustered, and looked through his notes and those in my folder. “Er, let me consult with my senior. I must get the discharge form”. He left the room.

One of the students spoke (the other had left, following the doctor). She was a pretty little thing, spectacles and light brown hair in a bob. Later, she reminded me of the actress Lily James. It was already 4.30pm (I had been in the room since 3.30.)  She had remained. I like her for her dedication.

“You can’t have imagined having [the congenital condition]. They [doctors] don’t listen”. So she too had picked up his condescension. Also, this was how they were trained now: listen to patients (the patient-centred approach).

I warmed to her support and eagerly took it up. “The clinic, when it was still in the old hospital [building before the new one was built], diagnosed me back in the day. I couldn’t have looked it on the Internet because there was no Internet.”

Kenya implied I invented the congenital and present conditions, which given what I experienced over the past year was insulting. But the former was diagnosed and I experienced the latter. It's a fact infections in the body, like dental, can affect adjacent areas and travel in the bloodstream and cause problems in other places particularly if there's an existing defect. After my severe dental problems were treated from May to September, I felt better overall. This suggests my theory about the connection was right. As I said, a simple blood test, e.g. ESR, in October 2019 or April 2019 when I told Mphisi I had an infection would've discovered it. House would've known this and what to do. 

I asked what year she was in (fourth). There may have been other small talk. Then I wondered aloud, “He said I was discharged. Why does he need to consult his senior? And fill a form?”

“Probably legal reasons”, she replied.

“More likely to cover them if anything goes wrong later", I said, smiling. She smiled slightly, not wanting to contradict anyone.

He returned with senior registrar Dr Jamba behind him. Jamba sat on the corner of the desk and asked somewhat aggressively, “Mr Johnson. What’s wrong?” I replied Kenya told me there’s nothing wrong with me. And I can be discharged.

He looked at my file. He and Kenya spoke, Kenya telling him my existing conditions – that I don’t have the congenital one – and his findings. Jamba looks at me and said, “You’re fine. There’s nothing wrong with you. You can be discharged.” At least he didn’t put it all down to worry.

Kenya completed the script for chronic medicine and the discharge form, which he handed me. “What must I do with this?” He replied uncertainly, “Give it to the day clinic [see postscript of this post] that will take over your care”.

It was almost five. We, including Lily James lookalike student, got ready to leave. She wished me good luck. I said goodbye. I liked her. She would make a good doctor if she stays the same. 

The corridor was empty except one nurse, gate keeper to the clinic’s inner sanctum. Kenya was in a hurry to leave. The nurse reminded him to give me a script. I wanted to leave too and told her I can get medicine at a private pharmacy, which I’m already doing. She said that’s expensive. He looked for a script pad then remembered he already wrote one. He left.

Earlier, before his examination while I gave him my history, I asked him to refer me to the relevant outpatients department for lower back pain. Initially he was receptive, then changed his mind and said my present problem was more important. My back could wait. But since he discharged me, I hoped he would give me the referral. He didn't.

The outpatient pharmacy was closed. I returned the following morning to the clinic at 9am, collected my folder, which contained the script, and got to the pharmacy at 9.15. I handed it at the counter. There were about 10 people including a few at the serving windows. At 9.30 the pharmacist (or assistant) called my name. She said they don’t stock the drug on the script – also the one my private doctor prescribes me – but have a similar one in that class.

The second drug on the script is only available in 40mg, not the 10mg I needed. She said I can’t break that into four parts of 10 mg each because, “There’s a line down the middle of a tablet. All the drug [the effective part] is in the one half [sic]”. This was ludicrous but I didn’t respond. I asked her to call the doctor for approval to change the first one. She went away and returned and told me the doctor must change the script himself.

I returned to the clinic at 9.40, told the nurse why and sat on the bench. Kenya came out of the examining room he was in the previous day. I attracted his attention. He said he’d see me later and went back into the room.

At 10.10am Jamba appears. He's surprised to see me, doing a double take, like, we got rid of you and now you’re back, you malingerer. I tell him there’s an issue with the medicine and hand him the folder to him. He reads the script and goes into Kenya’s room. He returns, gives me the folder and said Kenya will deal with it. He walks off.

I wait. This is Groote Schuur and Western Cape public health. A short visit ends up twice as long and complicated. They seldom get it right the first time – if you don’t succeed, try, try again.

At around 11.30am Jamba comes out his room and tells me to come with him. He amends the script to what’s in stock (the pharmacists told me government bulk buys certain drugs of a class only). I ask about the referral for my back. He tells me he can’t without reason; the other department would want to know why. He asks to look at my back but doesn’t examine it. I mention a CT scan. He orders an X-ray and tells me to return after it’s done.

Radiography is two floors down, C floor. A few patients are waiting. A sign says expect 90 minutes and I settle for the wait. But 20 minutes later a young man, presumably a radiographer, calls “Mr Thomas”. A man gets up and goes with him. He returns and calls Mr Thomas again. I rouse myself and ask “Thomas Johnson?” He looks at the folder and says “Johnson”. Thomas is also a second name. It’s a common mistake.

In the X-ray room a couple of apparently student radiographers position me this way and that on the table. A radiographer, a young woman, looks in. Another student eagerly wants to do a mobile X-ray in a ward. She asks if he’ll be back by 1pm. He says yes.

They take the pictures and she returns to position me again. When it’s over she says, “Good luck, Mr Johnson”. Good luck? I wonder if I should I be worried. For a moment I want to ask her what the X-rays show but know they’re not permitted to and the moment passes.

When I get to the hospital’s central corridor, Kenya is entering the stairwell opposite the clinic. I give my medical folder to the nurse and tell her I saw him leave. What now? “They will call you”. They never did.

The previous evening after I arrived home, in rush-hour traffic with engine trouble, I looked at the discharge form (“OPD discharge letter”). The form is a referral letter to the primary practitioner who will take over the patient’s – my – care. It contains a list of conditions and diagnoses for the conditions the patient attended the clinic for. 

On the first line under existing conditions Kenya included the congenital defect he had said I didn’t have. He had “cured” me of it, and moments later, with a stroke of a pen – not clinical exam or scans – reinstated it or “relapsed” me. But he did not sign and date the form so it has no worth as a medical document.

This is another example of the “fantastic” care one gets at Groote Schuur Hospital, Western Cape Health Department and UCT Medical School and their wonderful, brilliant doctors that they frequently boast about.

Or it’s as I’ve said in his blog, it reflects the often slap-dash, inattentive and poor and sometimes negligent healthcare.