Phone MD

Telephone call for urgent telephone specialist advice regarding their patient. Call was answered immediately. A discussion of pertinent family/patient history, history of presenting complaint, relevant laboratory investigations, review of chart, relevant imaging tests, and discussion of the patient's condition and management was held. This telephone discussion and advice obviated the need for urgent specialist consultation and call out. Phone times entered in calendar, hover over appointment. Dr. Anya Sharma 14:00 - 14:15 PST History of presenting illness * Patient is a 58-year-old male presenting with intermittent epigastric pain and dyspepsia for the past 3 months, worsening over the last two weeks. * Pain is described as a burning sensation, occurring mostly after meals and occasionally waking him at night. It is partially relieved by over-the-counter antacids. * He reports associated bloating and early satiety but no nausea, vomiting, dysphagia, or weight loss. * Family history is significant for a father diagnosed with gastric adenocarcinoma at age 65. * Recent laboratory investigations (last month) showed normal full blood count, liver function tests, and amylase/lipase. H. pylori stool antigen test was negative. * Previous endoscopy 3 years ago was unremarkable. * No relevant imaging tests have been performed recently for this complaint. Past medical history Patient has a history of controlled hypertension, managed with Amlodipine 5mg once daily, diagnosed 5 years ago. He also has mild osteoarthritis in his knees, for which he occasionally takes ibuprofen. No known allergies to medications. Medications * Amlodipine 5mg, once daily, oral. Patient reports good adherence. * Ibuprofen 400mg, as needed for knee pain, oral. Reports taking it 2-3 times a week recently due to increased pain. * Gaviscon Advance (OTC), as needed for dyspepsia, oral. Patient reports taking it daily, often after meals, with temporary relief. Suggestions * Recommend an urgent gastroscopy due to the patient's age (>55) with new onset dyspepsia and significant family history of gastric cancer, despite negative H. pylori. * Advise patient to stop ibuprofen immediately and consider alternative analgesia for osteoarthritis, such as paracetamol or topical NSAIDs, to reduce gastric irritation. * Suggest a trial of a Proton Pump Inhibitor (PPI), such as Omeprazole 20mg once daily, to be initiated until gastroscopy can be performed. * Educate patient on alarm symptoms (e.g., dysphagia, weight loss, persistent vomiting, GI bleeding) requiring immediate medical attention. * Referral for urgent gastroscopy to be arranged within the next 2 weeks.