Human Machine

Human Machine

owner’s manual & basic trouble shooting

Dr Tony Marshal, MHP(NSW); FRACGP

Human Machine

Copyright © 2015 Tony Marshal

Smashwords Edition

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.

The information, views, opinions and visuals expressed in this publication are solely those of the author(s) and do not reflect those of the publisher. The publisher disclaims any liabilities or responsibilities whatsoever for any damages, libel or liabilities arising directly or indirectly from the contents of this publication.

A copy of this publication can be found in the National Library of Australia.

ISBN: 978-1-742845-24-1 (pbk.)

Published by Book Pal

www.bookpal.com.au

To Ali,

Who never writes

Preface

Once I was visiting an art exhibition where another visitor asked the artist how long it had taken to do one particular portrait. The artist was very diplomatic. She simply said, Well, let us just say, I started it when I was much younger!

I felt there is a need for a manual such as this very early in my career. It was not lack of interest that appeared to prevent people from learning about their body; they simply had never had a meaningful opportunity in school or later, to be shown.

Some of the pages in this manual are based on those I have used as information sheets from time to time, in my daily practice. Over the years I have added bits and pieces as I have felt a need for them. Some of the anecdotes incorporated here are intended to illustrate the art involved in the science of medicine.

I should acknowledge my deep gratitude to my personal assistant Sarah Hemmingway who has been enormously helpful in typing the manuscript and general organisation of it while simultaneously running our practice. Also to my practice nurse Cheryl Brockwell who helped especially with updating the appendix A.

The original draft was first read by Mr and Mrs (Neil and Sandra) Graham who did the first round of editing for me. It was later read and commented on by Mr Rob Morgan, Mrs Sandra Sexton, Ms Joanne Booth and Mr & Mrs Ian and Rae Edwards.

The book was also read over the months by many of my colleagues, including Drs Joe Radcliffe, Damien Flanagan, Bernie Boon, Andrew Ling and Professors Max Kamien and John Murtagh who gave valuable advice, to improve it. I am grateful to them all.

Any suggestions and criticisms are welcome and will be considered for future editions.

They can be sent to playnest@iinet.net.au

Tony A. Marshal

Introduction

It is common, and in fact a requirement that we are provided with an owner’s manual for even the simplest gadgets we obtain. However, amazingly, an average Joe Blog, being in possession of such a surprisingly complex machine as the human body, most often goes through all his life without ever having read even a basic book about human body!

Although there are many excellent books on all aspects of medicine, I personally have not come across one specifically intended for a layperson in a concise yet adequate format. It is this gap that this manual hopes to fill.

The point has to be made here that reading one book will not and cannot make you a doctor. More to the point, even reading a thousand books about health topics and medicine will not make you a doctor. It is not the intention of this manual to do so in any case. It is studying hundreds of books on medicine, under supervision and passing many examinations that may make you a doctor, in the right environment (Medical School).

This book is unashamedly and unapologetically very basic in concept and content. Although it is not intended for the lowest common denominator, it certainly is for those who want to have a basic general knowledge about their body and the most common ailments they may suffer and what can be done about them.

Such a person may be a clerk or a carpenter, a labourer or a lawyer, and or a builder or a banker. In fact my hope is that this manual may one day be placed on the reading list of high schools in Australia and beyond.

It is basic enough to cover a picture of a cell and to deal with such common questions as to why do we need a referral to see a specialist?

Some descriptions of topics covered here may not be absolutely accurate from a strict anatomical or physiological point of view. This may have resulted from my attempt in simplifying such concepts. However it is hoped it will be useful for the uninitiated in matters medical.

The yard stick applied for choosing the type, length and depth of the topics discussed here is solely my own personal experience of nearly 25 years as a GP.

Although there is a great danger in generalising any given situation, I hope my choice of the topics and the rather superficial discussion of some of them, will not displease the more initiated.

Of necessity for brevity therefore, only some of the most common symptoms and conditions will be discussed here. The more uncommon conditions will have to be considered by a doctor who may discuss them as they arise.

Sometimes the opinion of the patient and the doctor about the nature of a problem at hand will be vastly different. The reason is that while in the majority of the circumstances the patient sees the trees, the doctor will be seeing the woods. The doctor will see the presenting problem in its broader context.

This ability will have resulted only after studying the human anatomy, physiology, etc., and it is even more likely if the doctor knows the patient, i.e. has seen them at least few times before.

It is with the risk of appearing to be old fashioned and conservative that I state that the doctor knows best is still a valid maxim, although the more enthusiastic health activists tend to encourage people these days to have fully informed discussions and to ask for choices from doctors.

It is fair to say that doctors will always have your best interest in mind and will always advise you to the best of their ability not only to help you but also ultimately to save themselves facing adverse outcomes.

The following subjects are some of the areas covered in a medical course.

Biology

Embryology

Histology

Physiology

Anatomy

Biochemistry

Pathology

Pharmacology,

As well as a host of clinical subjects including:

Gynaecology; Ophthalmology; Otorhinolaryngology; Paediatrics; Surgery; Psychiatry and so on

A brief explanation of each of these subjects and specialties will follow in the ensuing chapters.

How lucky we are if we do not get sick every day of our lives

There are at least 500 species of influenza viruses alone, some 700 muscles, 600 bones and more than 2000 skin diseases.

On the other hand, supposing a lucky person lives a hundred years, there will only be 36,500 days in his/her entire lifetime.

Considering the number of pathogens, and the number of body parts that there are, you can well imagine how many tens of thousands of diseases there are out there potentially ready to strike.

This really means that we ought to be a very lucky person indeed, to not suffer at least several of these potential afflictions, each day, on average.

The fact that this doesn’t happen is due to the extra ordinary design and resilience of the Human Machine. It heals itself most of the time and has an amazing security system within it (immune system) that fends off most of the offending agents, most of the time.

Extent and Scope of GP Work

A GP’s job may look easy most of the time, especially with the advent of computers these days. The reality is that a GP, to be effective enough, more than any other specialist has to have a working familiarity with tens of thousands of afflictions that can affect the human body and mind. Many of these problems are not always as straight forward as a sore throat requiring a script.

The doctor will always rely on three sources of information to reach a diagnosis:

History: This will be given by the patient as well as taken by the doctor. If for example the problem is pain, the history will clarify the duration, location, associated symptoms, relieving and aggravating factors and so on. Then that information will be put in the background of age, sex, occupation, past medical history etc. By the end of taking a good history the doctor should have close to 85% certainty of diagnosis and should have come up with a list of likely possibilities. (List of differential diagnoses).

Examination: This will involve not only the location of the presenting problem but also a general examination of the rest of the relevant system and of the body as a whole. The latter may look irrelevant to the patient but rest assured that the doctor will not spend time on any irrelevancy. By the end of the examination the doctor should have shortened the list of possible diagnoses and should have reached to close to 95% of diagnostic certainty. The examination starts from the minute you walk in the consulting room and continues throughout the consultation when the doctor will be observing as how the problem presents.

Investigations: A variety of investigative means and methods are there to confirm or exclude certain diseases. They range from blood tests to X-rays, Ultrasounds, CAT, MRI, and PET scans, or DEXA tests and so on. There are virtually thousands of blood tests alone that can be done depending on the problem presented to the doctor.

Still the diagnosis may be elusive at times, and even the most experienced GP may be at a loss as to the diagnosis. Sometimes it may only be possible to arrive at a diagnosis after excluding many other possibilities (diagnosis by exclusion). Again sometimes all that will be possible is to reasonably state that on the balance of probabilities, the complaint is not of a serious nature and will only therefore require reassurance. Indeed, most of a GP’s time may involve reassurance and explaining variations of normalities.

Even a good GP, occasionally, may not be able to work out what a patient’s diagnosis may be.

This is to say, living with uncertainty is part of the nature of any doctor’s practice and there are numerous grey areas.

One of the first things that a GP will try to decide is whether the problem is an emergency or not, and whether to investigate or to observe the presenting problem and reassure for now.

A story:

A painter asked a doctor friend to come and take a look at a painting he had just finished. As expected, he was very proud of it and thought that it was one of his greatest creations. So naturally, he expected complimentary comments from his learned friend.

The doctor examined it, observed it, and looked at it from left to right, from top to bottom and from back to front. This took more than half an hour, but he still didn’t say a thing. Meanwhile, the painter grew more and more anxious as to what was wrong with his creation.

Eventually, the doctor only said, It looks like a double pneumonia!

A Full Examination; in my experience

I’ve just come to have a testosterone test and for a medical certificate for tomorrow - I am too tired to go to work. He was about 35 years old and had an unkempt appearance. It was the first time he was attending my practice so I didn’t know him. He had a poor grasp of his own medical history and evaded the questions I was asking in my attempt to unravel his concerns.

After a long time it transpired he had erectile dysfunction and was a heavy marijuana user. Obviously he had his own agenda and wanted to achieve it in the quickest time possible.

Rather than a serum testosterone, I offered him other tests for erectile dysfunction screening and to check for diabetes etc. On the positive side, however, given that I still was in a good mood, I told him I was prepared to issue him a Medical Certificate not only for the next day, but also for the rest of the week if he liked, even for the rest of the month if he insisted!; but only if he took some of my advice on-board. Unfortunately he had made up his mind about what he wanted. He refused the blood tests I suggested and wanted a Medical Certificate for the next day only.

I spent more than the minimum time required for a long consultation and I gave him a bit of counselling regarding the hazards of smoking marijuana. Part of what I said was the warning that continuation of smoking marijuana could possibly make him prone to schizophrenia. And what is that? he asked. So I had to explain that people with schizophrenia might come to their doctor stating, for example that they had just had breakfast with Mr Christ or are