To ground or not to ground

In addition to diagnosis and treatment, the GP must sometimes make a last-minute decision whether to allow a patient to travel or to ground them, causing the loss of their non-refundable airline ticket. The physician can become annoyingly hesitant in making the correct decision.

An 80-year-old woman, who had been my patient for the past 30 years, had reserved a flight to France on Sunday at 8.00 am. She came to my clinic on Friday evening with a typical glossopharyngeal neuralgia, in a panicky state, and afraid to lose her $800 ticket should she be unable to travel on Sunday. She had been to an otolaryngologist who had found nothing wrong with her physically and had asked for an MRI of the brain, charging her $100. She said she could not spend more, and I assured her that I would not charge her.

I started her on carbamazepine 200 mg b.i.d. She called me on Saturday morning when I was at our summer home 60 km away, thanking and praising me for the ‘miraculous’ disappearance of her pain and her regained hope of travelling next morning. In the evening she called me again saying she had developed severe dizziness from the carbamazepine, and that her sons waiting in France had checked on the internet and told her that carbamazepine was for epilepsy. I explained to her that it was also the best drug for her neuralgia.

I told her to skip the next dose and also the Sunday morning dose, rest for the night, and ask for a wheelchair at the airport (which she had originally done already). I assured her that the side effect of the drug would be gone by the morning.

There was no further communication from her, nor from her sons in France, nor from her daughter in Australia after that evening call. My sleep was disturbed for two nights, not knowing whether she had made it to the airport, or had missed the flight and lost $800, or, worse, had gone to the emergency room.

On Tuesday morning, having come back to Beirut, I passed by her building and rang the interphone. There was no answer, and I was relieved. But could she be at the hospital instead of in France? Fortunately, the concierge was around and told me he had helped her to the taxi that took her to the airport.

• © British Journal of General Practice 2020