Greetings!   Just to share ....   Two weeks ago...i treated a regular patient of mine Alan for headache and giddiness. After 5 days of treatmant with the symptoms not totally relieved although was better and occuring only occasionally. Alan's wife Lynn ask if he should be refered for further investigations and scans. Giving my opinion at that time, i told them it was not necessary  from my clinical assessment and patient's condition. I don't see any substantial reasons to investigate further at that point in time, explaining patiently my reasons in length... which is a long list to name. Alan and Lynn was convince at that time in the aspect that they did not ask me to write a referal to the hospital for further investigations and continued with the madication i prescribed.     Two days ago, Lynn came to see me asking me to write a referal for Alan to see a neurologist ( Brain Specialist) on the recommendation of a friend. She told me that Alan actualy went and got himself admitted to the hospital two nights later after our last consultation upon the persistent goodwill nagging of his boss to just get the investigations done since it is the company or rather the insurance company is paying for it. So he got a series of Ct scans and MRI with Blood tests, ECG Stress test for the Heart etc etc done, staying 2 days in the hospital with another 2 specialist consulted. Lynn told me all investigations were NORMAL and he was prescribed similar medication given by me earlier on top of a bill of 4K plus to settle by the insurance company, of course. She shared with me she and Alan was not surprise that everything turn out normal and she said " Dr. Wong has all the time been accurate with her views  from the many experience we had with her, although we proceed further is just for a second peace of mind". This time Lynn told me although her husbands headache is still present although minimal and inconsistent, but due to Alan's boss again pastering him to seek for another opinion of a nuerologist, she would appreciate i write him a referal now. Anyway...i told her, since you have gone this far, i guess there's no reason why i would not write you the referal to see a neurologist for another extra opinion. I suggest i recommend her to see a fellow ex-colleague neurologist of mine, but Lynn says they want to see this neurologist recommended by a friend, giving me the reason that they don't like the private hospital where my recommendation goes.     Yesterday evening while having my dinner inbetween my consultation hours, my nurse inform me that Lynn is waiting anxiously to consult me for an opinion.Hearing that, i decide to leave my dinner and see her first..probably something serious enough to cause her, a known "Happy Go Lucky" type of person to be in that state.. She came in with Alan and her 2 young children...the whole family in union. Alan inform me that they saw the neurologist that morning and was refered to see an opthalmologist( eye specialist).The opthalmologist replied that, he finds, through Alan's eyes, shows signs of increased brain pressure...and would not comment further if it was of any significance, asking them to relate back to the neurologist.The neurologist suggest that he undergoes a tapping of the brain fluid to confirm if it is an infection or a blood clot causing the "increase in pressure". Wise and rational, Alan question all the risk involved in such a procedure and the possible results.One of the answer he got was that, it could just be normal results after the tapping ie no cause for the increase presure... but bearing in mind having to take the consequence risk of a persistent headche and to be put on long term medication for the headache...plus all the other risks as well..     Now the dilema comes......   1) Alan felt he is getting better with whatever medication given so far.   2) It does not look like he is so debilitated with the primary problem of a headache, so much so that he don't feel the urgency to continue the investigations further by going through a brain fluid tapping ( much againts the neurologist opinion) and ended up with a long term persistent headche the rest of his life..    3) Why the opinion of doctors differ so much   4) Is it not all the investigations done so far normal? Meaning to say the investigations done are not accurate?..what is the rate of false negative?     Above all this dilema Alan is questioning....It also affect Lynn so much so, that, Alan told me his wife have been very upset and cried the whole afternoon after seeing the neurologist...inspite of all his assurance and comfort he gave her...that he is not "sick".     Well....I had a long talk with the both of them, sharing my humble opinion again, which i hope i could at least help to relieve their anxiety... as it will still be their mindset again on what they chose to do next with this dilema...although i don't doubt they still trust me enough to continue seeking my humble opinion.   Has it not a headche became a bigger headache??

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