Thread by @DrSeunO

Finally, some me time....

OK, been long I did this.... Lets get back into the mode gradually.

As usual, all names are fictional
Here goes:

[knock, knock]

"Your next patient has arrived"
"Please let him in"

[Mr. Akinade enter, bag in hand as usual. He owns a 6 petrol stations in the state, 6 different estate in 3 state. He dresses well, always looking pristine and sharp with a wicked sense of fashion.

He speaks with a measured tone of assurance and confidence]

"morning to you sir, how do you do today"
"I'm very well doctor, no I take that back. I'm not feeling too good" he responded.
"alright, what is the problem?"

"I haven't been feeling quite myself for some months now, roughly about 6 month. But I have been too busy to get medical attention. So today, my schedule cleared up, I thought I should find out what is going on with me before man pai" he smiled

"Ok sir, but you still haven't told me how you feel exactly"
"that is because I do not know how I am feeling, àbí ó gbó, mo mọ bó ṣe ṣe mí"
"I wake up in the morning, I'm tired. Infact to get out of bed is war. My body aches like ẹni tó ru pọn pọn"

"like the Klitschko that Anthony Joshua fọ̀ lẹ́nu dànù dànù. In other words, I wake up with body pains. I lack energy almost throughout the day. I must say there are times when I feel OK but that is far in between"

"infact ehn, madam is beginning to complain" he said in low voice

"won gbọ́dọ̀ gbó pé ọmọkùnrin o'lẹ́ perform na, háàha háàhaa dókítà

"there is also this slight temperature, I don't feel my body is hot when I touch it, but I can feel it internally. Then their is a bit of headache as well. But that tiredness and exhaustion is the koko of the matter." he continued

"since I don't joke with my health, I did some test, Full blood count, Malaria Parasite and Widal test"

"who recommended the test for you sir"

"Nobody ooo, I did it on my own, since I know that what you will tell me to do. I mean, that what my previous doctor always do"

"so help me solve this tiredness ooo. I am too young to die"
"let me have those results" the doctor requested

[the doctor asked questions to complete his history and examined him]

"there is nothing wrong with you sir, at least not in the way you are thinking" the doc stated

"Nothing báwo, don't tell me nothing na. Look at those test results again, there is something there"

[the doctor look at the test results again]

"there is nothing wrong with you sir. Don't get me wrong, you are definitely feeling what you say you feeling"

"you are feeling tired, you are feeling weak, you feel pain and headache. You even feel slight body temperature as you said. But there is nothing wrong with you"
"this is the reason why I don't like you doctors, this is the reason why I like the lab people and chemist" he started

"I go to the lab, I tell them how I feel, they do the test and tell me what is wrong. They even suggest what drugs to take. I get to the chemist and get the drugs and I feel OK when I am done with them. But you doctors will be forming I too know"

"the lab man already told me that I have Typhoid. He suggested I get antibiotics. I only came here to fulfil all righteousness. Look at the widal test na, can't you see it is written in red ink. Red is danger na"

"let me make a quick call" the doctor pleaded
"hello, Ms funmi, when is my next appointment scheduled for?"
"oh great, in 1 hour"
"that's lovely, just perfect, thank you"

"I'm with you again sir. I just wanted to know if I have enough time to engage and enlighten you"

"the Widal test is NOT A RELIABLE investigation in the diagnosis of Typhoid sir"

"Haaaa, dókítà dókítà"

"Oya, explain, sho lọ fe smart jù mí lọ ní"
[the doctor smiled😁]

"sir, for every investigation, there are two things that determine how useful they are in view of the symptoms that a patient present with" Doc started
"these two factors are called SENSITIVITY and SPECIFICITY"

"kí ni yẹn kò wá, what does that teach us now" Akinade retorted
"it is just English, Sensitivity means how sensitive to a disease is the test. Specificity means how specific to a disease a test is"
"we, doctors factor this in when deciding on what investigations to choose"

"ehn ehn. Go on, I'm listening"
"in the treatment of health, we want a test with high sensitivity and specificity, so that when I test for an illness, if it is says it is there, it is ACTUALLY there (Sensitivity).

Also, if it says this is what is causing the symptoms, that is what is causing the symptoms (Specificity).

If a test is not able to do this to the highest level, it can give us False Positives or False Negatives (meaning it can be lieing to us).

Telling us that an illness is not there when it is there or that it is there when it is not there.

"so for Widal test, what is the sensi and speci"

"the specificity of Widal test is about 66%, that is 34% chance of misleading us"

"the sensitivity is about 70%, 30% chance of saying a disease is there when it is not. If you want me to take this result seriously, then we need to repeat it in 2 weeks time, that is the recommended way to use widal test"

"so why do doctors request for it, I have met doctors who asked me to do widal test"

" It is very fast, result is usually under 1 min, sometimes this is the only available test in the community due to lack of resources for other investigative method. It also very cheap"

"don't get me wrong sir, it is still a test and it will still be widely used for sometime to come, but if it must be used, then it must be used the right way. That is for you to have 2 widal test done, 10-14 days apart and see if there is a 4-fold increase in the titre value"

"what other test can I do, because I just don't like how I am feeling doc" Akinade asked

" There is Typhoidot (result in 15 mins), ELISA ( 45mins to 2 hours), Stool, Blood, Bone Marrow Culture ( 3 to 5 days), PCR (7 to 10 days).

"so what is wrong with me ooo doc"

"I believe you have Chronic Fatigue Syndrome"
"Chronic kini" Akinade screamed

"it just means you need a vacation"
"ehn ehn... Wà ṣeré"
"and it is a win-win for you, go for the vacation, rest as much as possible, and in 2 weeks time when you come back, we will repeat this Widal test. We will decide then if it is significant for treatment".

"Thank you ó jàre doc, all you young doctor. You are smart and brilliant. I will see you in 2 weeks"
"One last thing Mr. Akinade, I'm not a pepeye, I'm a doctor, not doc" the doctor said with a smile

They both smiled

#medicstoriesby@drseuno
#typhoid #widaltest

P.S: I am part of a group of Nigeria Healthcare Workers. The vision is to change the Nigeria health landscape via EDUCATION. We believe that with greater health awareness, Nigerian will be better off, this will in turn aid financial stability of individual citizens.

We are a team of Nigerian Healthcare workers, home and abroad. We are not just doctors, but pharmacist, nurses, dentist etc.

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