Doctors; let’s get naked……

One of the unwritten rules of general practice runs thus; the longer it takes for a patient to disrobe, the less likely there is to be any significant clinical finding.

There is obviously a huge cost implication for the NHS here. Instead of sitting there twiddling our thumbs or daydreaming or idly Googling to see what Britney Spears is up to, while Mrs O’Toole laboriously removes corset number four with a hammer and chisel, we could be doing something useful.

But I have a solution; some might consider it rather extreme, but at a stroke it would rectify this drain on scarce resources; we should all get naked. And not only patients; to maintain a balance in the doctor-patient relationship, doctors would have to get naked as well.

It’s not really such a revolutionary step. By this stage, nearly everybody has appeared naked in a fundraising calendar, and being honest, we know fundraising is just a handy excuse, some people just like getting their kit off in public

OK, OK, I hear you say, some of it won’t be pretty, have we not suffered enough?

But think of all the time we’d save. No need to worry any more about what suit to wear, whether our trousers are pressed, which tie goes with which shirt – a major source of stress would be history.There would also be less tangible, more spiritual rewards. Clothes have lost their traditional purpose – to keep us warm and dry – instead, our culture has become so trivial that clothes have become a statement, a status symbol.
Getting naked would liberate us from these pretensions, get us closer to the truth of who we really are; here I am, we’d say, this is me, I am a child of the universe, peace, love and rock’n’roll, this is my glorious naked body, no longer fettered by fashion and convention, and of which I am not ashamed, look on my works, Ozymandias, King of Kings, and despair.

The rest of society would also benefit. Going through security at airports would be a breeze; no more being herded into long queues like sheep, no more having to take off shoes and coats and belts, we’d be straight in there to the duty free and the free samples of expensive aftershave. Terrorists would have nowhere to hide their paraphernalia; well, maybe there’s one place, so a lot more rectals would be needed, but they’re not that bad, and can even be quite pleasant.

If performed by an attractive person, that is.

What rough beast?

British Medical Journal Published 25 April 1998) Cite this as: BMJ 1998;316:1324

I began this column in the BMJ almost four years ago; shortly after that, though it was almost certainly a coincidence, the IRA declared a ceasefire, and now another unthinkable and previously unbelievable advance is also imminent.


As I write this it is 3 o’clock in the morning, and my friends and I are sitting by the radio, sharing a few beers and waiting for news of a successful conclusion to the peace talks, something apparently impossible, contradictory; a compromise between two aspirations which had almost seemed defined by their mutual enmity. But now at last, and beyond all hope, it is happening.

The best lack all conviction, said Yeats, but the worst are full of passionate intensity. This observation has proved lamentably accurate; throughout Ulster’s history the demagogue and the rabble rouser has had influence way beyond their merits, and reason and common sense have suffered accordingly. But perhaps in these past few days there has been a sea change; we have seen passion aplenty during the peace talks this week, a real and tangible sense of urgency, of history, of the desperate need for agreement and understanding.

We doctors have not neglected our duties and responsibilities, nor remained aloof from the dispute. John Alderdice of the Alliance Party and Joe Hendron of the Social Democratic and Labour Party, who have been hammering away thanklessly for years; Jane Wilde of the Women’s Coalition, new blood with welcome new attitudes and priorities; all of them deserve the recognition and gratitude of our profession for their efforts, proof that strength and confidence do not forbid accommodation nor equate it with surrender, but rather demand a spirit of compromise and a willingness to see the other person’s point of view.

And, finally, thanks to John Major, out of the spotlight now, but whose commitment at the start of the peace process was utterly indispensable, and whose involvement came at a time when any political settlement seemed so far away as to be a dream for only fools or madmen.

Of course the agreement is not perfect, but in politics, as in writing and medicine (and life), perfect is the enemy of good enough, and there are many extreme influences out there who will reflexly view any compromise with suspicion. It is tempting to dismiss these forces as bigots and gangsters, but in Northern Ireland embracing the extremes is a vital part of any solution; suspicion must be met with persuasion and reassurance rather than ridicule and dismissal.

We step outside to see the sun rising on a memorable dawn, a Good Friday full of historical significance and awash with dreams of a vibrant new future for ourselves and our children, and we toast it with a fine malt which might have been described in The Life of Brian as good enough for Jehovah. And if that wasn’t hopeful enough, Ben Hur is on television this afternoon to fill that spiritual vacuum that pervades all our lives in this material world; is that a good omen or what?

There are many obstacles ahead, but, as Yeats said, “What rough beast/It’s time come round at last/Slouches towards Bethlehem to be born.”

Immortality? No thanks……

GP Magazine 24 October 2017

Joe has strong views on death; he’s against it.

‘I read in the paper,’ he said, ‘that drinking coffee lowers your risk of dying.’

‘Joe,’ I said kindly, but with just a hint of malice. ‘Even the most vacuous, spurious, and sensationalist newspaper headlines always have a kernel of truth. Except for the times they don’t. This report is misleading; you cannot lower your risk of dying. It’s not optional, some day you will no longer be around to charm and delight future generations in the many, many ways you have charmed and delighted us.’

Death is simple, but vastly complicated. There is a cognitive dissonance here; we know we are going to die, but we don’t really know it. It’s down the road a bit, just round the corner, out of sight, and we wouldn’t thank anyone for informing us precisely the date of our future demise; we prefer to let ill tidings tell themselves when they be felt.

As we get older, the evidence for our certain demise accumulates; sickness piles on sickness, cancer piles upon degenerative disease, piles pile upon piles. It’s a grim prospect, but as usual, cognitive dissonance makes the world go round and stops us all being depressed by our own mortality and the weakness and fragility of our flesh.

And who wants to live forever? As Tennyson said: ‘Old men must die, else the earth grow mouldy’; from Tithonus babbling endlessly in loathsome old age in the palace of dawn, to the sad plight of the struldbrugs in Gulliver’s Travels, the perils of immortality have been well signposted. The first man to become immortal (or more strictly speaking amortal, you can always get hit by a bus) will be a hero; they’ll fete him and praise him, and he’ll definitely get laid. But then jealousy and rancour will set in, and our hero will realise that boredom is the new black.

‘Joe, I said, ’You and I shall grow old and diminish together, and share a comfortable and mellow dotage.’

Even speaking these words made me depressed; a dread vista, Joe and I, together, for years and years, forever………

Warning! Humans working in the NHS

GP Magazine   3 March 2014

‘It is always the best policy to speak the truth,’ said Jerome K Jerome, who then added an important qualification – ‘Unless, of course, you are an exceptionally good liar.’

So we all owe a debt of gratitude to leading surgeon Professor J Meirion Thomas; his unpalatable truth is that ‘the gender imbalance is already having a negative effect on the NHS’. Most female doctors, he explained, end up working part-time – usually in general practice. They tend to avoid the more demanding specialties, which require greater commitment, and look for a better work/life balance. Doctors also tend to marry within their own socio-economic group and, he observes, in many cases, the wife is the secondary earner, which further encourages less demanding part-time work. Not only lazy bitches, you see, but lazy and snobby bitches as well.

The professor also pointed out that as: ‘GPs tend to work in small group practices, there is a danger these can become backwaters, isolated from the nourishing influences of hospital medicine.’ The obvious solution, which he probably omitted for brevity, is for everybody to live close to a hospital. General practice, he concluded, is organised for the convenience of doctors – particularly female GPs – not their patients.

As you might expect, there was fierce condemnation of the professor’s remarks from the usual suspects, all aflame with righteous outrage; we can’t handle the truth. In reality, the professor’s honesty didn’t go far enough. I can reveal that there are also men working in the NHS. Let’s be honest, men are pigs; I’m one, so I should know. Shallow, venal creatures, exhibiting all the vices, except perhaps greed, which requires a bit of energy.

How the NHS continues to function with such a large percentage of men and women in the workforce is a mystery. The truth is, you can get a lot done when you don’t have, you know, a life.

Farrell, Dr Liam. Are You the F**king Doctor?: Tales from the bleeding edge of medicine . Kindle Edition.

Good Advice……

British Medical Journal   6 July 2002

As with a tip for the horses, the responsibility for advice lies not with the donor but with the recipient; words are very cheap, and ultimately it’s your choice whether to act on them or not.
On my first night as casualty officer in a Dublin hospital a young man was brought in unconscious. In those days I was quite thorough (I’ve matured since), so—among other things (such as pressing knuckles on his sternum to check he wasn’t faking)—I ordered a drug screen.
I then received a call from the lab technician who explained politely that it was not lab policy to perform drug screens on unconscious patients without certain other indications. They had a protocol, she said. I can’t remember what these indications were, but in those days, protocols were new-fangled and sounded quite impressive.
In those days, also, I was easily persuadable (I’ve matured since), so I accepted this explanation. But when I described what had happened over coffee to the medical registrar, who’d been working there for donkey’s years, he bristled with rage.
‘I’m sick of those bastards,’ he said, ‘What do lab techs know about patient care? That guy is your patient, you are the doctor, you are on the front line, you make the decisions; you are responsible, if something goes wrong, it won’t be the lab tech who gets the blame. The buck stops with you, and if you think you need a drug screen, damn well order it;’ it was pretty rousing stuff.
Once again easily persuaded (sometimes this is not such a virtue), I rang back the lab tech and damn well ordered the drug screen done stat, with no arguments and no messing, right? I was the doctor, he was my patient etc.
A few minutes later, the casualty sister came in and, portentously discreet, whispered deafeningly and rather moistly in my ear that the professor of chemical pathology wanted to speak to me at once.
‘F***,’ said the reg, making the traditional medical hand-washing gesture, ‘You’re in big trouble now.’

Footnote; a true story

Waiting; we don’t understand it

GP Magazine    4 April 2016

‘Nothing happens. Nobody comes, nobody goes. It’s awful’ – Samuel Beckett, Waiting for Godot.

Waiting is something we doctors don’t comprehend; we’re always busy, always rushing, always overstretched. It may even have a bright side; watchful waiting, or masterly inactivity, we call it, as we know things often get better on their own, or that a bit of time can make the picture clearer.

In contrast, waiting is a huge, exhausting, and onerous part of the patient experience.

They wait for an appointment to see us. They wait while I explain that antibiotics are not appropriate in this case, have many side-effects, and contribute to the global problem of antibiotic resistance, and then They wait as I grudgingly write out the prescription for an antibiotic.

If They have be referred Their problems are only starting, as They are then plunged headlong into the labyrinth of bureaucratic healthcare inefficiency.

They wait for the specialist appointment, for weeks, months, maybe years. They wait for the scan or scans, They wait for the report on the scan, which can be good or bad news. They wait for whatever procedure may be indicated, and probably have it postponed a few times just to add to the ordeal. And if admitted to hospital, every day They will wait for the ward-round and for visits from family and friends.

I tell my young colleagues, ‘Your patient will have been waiting for you, sometimes for hours and weeks, even months, so no matter how busy you are, give them your full attention.’

But sometimes it has a happy ending.

‘I’ve been waiting for twenty minutes,’ complained Joe.

‘Then I’ve got good news, Joe; no more waiting,’ I reassured him.,’There’s absolutely nothing wrong with you.’

At Christmas, GPs are ready for anything…….

GP Magazine  21st December 2008

I used to love Christmas, but I loved it too much and it could never live up to my expectations, so rather than continue to endure such annual disappointment I turned my back firmly on the festive season.

‘Ah, distinctly I remember it was in the bleak December; And each separate dying ember wrought its ghost upon the floor.’ Around the time Edgar Allen Poe wrote those lines I was still on a one-night-in-two rota and the holiday period was nothing but a prolonged torture, a succession of long winter nights, all the time acutely aware that normal people were out enjoying themselves.

Sometimes the local church choir would come around, mugging immigrants and singing carols and collecting money for Sister Eucharia’s hernia operation; ‘Get out of my face before I hurt you’, I’d say kindly, though in the end I’d relent and give them the traditional prescription for antibiotics, what with it being the time of giving and all.

Then, this year something strange happened. I answered a midnight knock on the door and saw a middle-aged man with a magnificent beard and a ‘why me’ expression on his face, a young woman sitting on a donkey, a squad of shepherds and three old guys with big parcels under their arms.

As a GP you have to be ready for anything; I’d read the book, I knew the score.

‘There’s a stable out the back, plenty of straw, no smoking please, a few appropriate barnyard animals, not too much manure, should suit you nicely,’ I said.

‘That’s not why we’re here, doctor,’ said the magnificently bearded man, ‘The Child is pulling at His ears …’

Are you the f**king doctor? Media coverage

Interview with Miriam O’Callagahan