Looking good...feeling awful

By BBC Doctor Colin Thomas

I tend to avoid telling patients they look well.

For a start some patients seem to see it as a deadly plot I've hatched to avoid having to give them something for their ills.

In the past I have also been caught out twice by two cases where 'looking well' can mean anything but!

When helping diabetics with their medical care, one of the battles we have, especially for those who have late onset diabetes, is keeping their weight in check.

The increase in the number of late onset diabetics has been related, we believe, to the spread of obesity, so if a diabetic has good control of their sugars, and is losing weight then we as doctors are deliriously happy.

However in one case my contentment was misplaced.

Previous doctors in training had always been struggling with this particular lady's weight, but imagine my delight when on taking over her care as the next junior doctor she started to lose weight at each review appointment.

Her diabetic results looked very good, she was well, and to cap it all she had a nice rosy glow in her cheeks. The patient basked in the reflected glory of her new found diabetic control, and I suppose to an extent so did I.

The situation continued until a few months later when she saw my boss in the clinic. At this point she was still looking rosy cheeked, but had now in addition developed a troublesome cough and night time sweats.

The lady in fact had been losing weight because she had developed tuberculosis, and I subsequently found out that on occasions those with TB will develop a little colour around the cheeks.

I'm afraid to say that when she started on TB treatment her diabetic control and weight assumed their awful pre-TB levels.

No medical miracles

I suppose that taught me that medical miracles, however much we hope, are unlikely, and if you think you've experienced one check everything else very carefully. The other occasion was a young lady who had recently returned from abroad and came to see me feeling unwell.

She looked very well indeed, and had a suntan following her journey.

Her symptoms of general tiredness and being off her food were worrying, and on testing her urine the reason for her symptoms became clear.

She was suffering from jaundice due to having contracted hepatitis A, probably from eating contaminated food abroad.

When I went back to examine her more closely I could detect a whisper of yellow in the white of the eye, but the tan had effectively masked what in a pale and interesting skin would have been all too obvious.

On that occasion I was jolly glad I hadn't taken her looks at face value.

Yes you can be very swayed by peoples appearance, however unfortunately mine must have significantly deteriorated - patients have stopped telling me I look too young to be a doctor!