Updated: Feb 3, 2020
Last week my secretary, Iwona, took a call from the daughter of a patient requesting a second opinion for his reflux symptoms. Gastroesophageal reflux is one of the conditions I treat and so, on the face of it, this was not unusual. Except that it was. The patient was in Uganda, which is where I was born!
Iwona received an endoscopy report from the patient scheduled a telephone consultation for today (Saturday) at a mutually convenient time taking into account the 3 hour time difference. I called the patient using WhatsApp and we both had crystal clear reception. I was able to take a full history from the patient regarding his symptoms, but importantly about lifestyle, diet and other medical conditions. He had made sensible lifestyle changes such as avoiding rich food and eating the last meal early in the evening. He had been told that he might need surgery for his persistent symptoms but I felt that with some more lifestyle changes and taking a PPI such as omeprazole, he may well be able to control his symptoms and never need surgery.
Antireflux surgery is very effective for controlling reflux but has a 10-20% failure rate over 10-20 years. Although re-operation is possible, the results are not as good as primary surgery and the complication rates are higher. As tens of thousands of patients have undergone antireflux surgery in the past 20 years, many of them in their 20s and 30s, there are now many patients with failure or complications of antireflux surgery. In the UK alone, about 2500 patients undergo antireflux surgery every year. In my practice currently, about half the patients I see are for primary antireflux surgery and the other half are those with failed surgery or complications of surgery. So you can see why I hold the view that if reflux can be controlled by lifestyle measures and medical treatment, then one should hold off surgery.
Back to my consultation from Uganda today. It turned out that the patient lived near the place I was born in Uganda and knew a friend of my father's! It is small world.
It is wonderful that we are potentially all connected across the globe through digital technology. That I can see reports and chat to patients thousands of miles away as if they were in my consulting room in London and be able to share my expertise. I am happy to consult as I did today. I will start putting digital 'pins' on the world map to track my consultations! Maybe I will use Zoom which I have used for webinars and it has worked very well.