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.

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

Rubber gloves are the new black….

I was at a local Gaelic football match recently. These can be ferocious; the honour of the parish is at stake, the rivalry is ancient and atavistic as the peat, and we suffer none of the false bonhomie of rugby, i.e fighting during the match but best of buddies afterwards.

If we fight during the match, we fight after the match and at the next match and at the match after that and our cousins fight with their cousins (or marry them) and the feud goes on and on, gathering pace through seed, breed and generation even when the original cause of the dispute has long been lost in the mists of antiquity. If any of our neighbouring clubs were playing the flesh-eating monsters from outer space, we’d be cheering on the aliens.

‘More substance in our enmities/Than in our love,’ wrote WB Yeats, who in between talking to the fairies and pouring out his unrequited love for Maud Gonne, had obviously been at a match or two in his time.

During the match a player went down with an injury. My cronies looked at me expectantly, hoping I might provide a diverting and potentially hilarious spectacle by sprinting onto the pitch to provide succour; they always enjoy a bit of drama. But my sprinting days are long over.

‘He’s fine,’ I said to them, ‘he’s still moving.’

They were visibly disappointed, but having to Break Bad News is just another part of the great tapestry of general practice.

The team physio (or bagman or trainer or waterboy) rushed out onto the field, stopping only to pull on a pair of rubber gloves although he had some difficulty with the thumbs. This was all rather theatrical, I felt, but then rubber gloves are quite the fashion accessory.

The actual risk of a clean-limbed young gossoon from the bogs of Ireland having AIDS or hepatitis B, and also having an open wound, and the physio/bagman also having an open wound and thus the pair inadvertently sharing body fluids must be incredibly small, but hey, he’d seen it on TV so it must be right.

Has there ever been a reported case of a physio/bagman picking up a serious infectious disease from a player during a match?

'Uh-Oh!'Rubber gloves, it seems, are the new black.

Beware of the rabbit……

This world is a dangerous place, red with tooth and claw, and none of us will leave it alive. It’s a jungle out there, a pasture for monsters and savage beasts, though often peril comes from the most unexpected sources, like the early scenes in Casualty, when someone is gardening and you know that one of those seemingly innocent garden tools is going to become an instrument of torture.

‘Watch out for the pitchfork!’ you want to shout, but it’s too late, and the pitchfork is sticking out of the neighbour’s naval.

‘The pet rabbit bit me,’ Joe complained, with a palpable air of betrayal and injured pride. ‘Et tu, Brute,’ he might have said. ‘What have I ever done to that rabbit, that it should hurt me so?’

I was not impressed; if the abrasion had been any more superficial it would have been a protuberance. Laying on the antiseptic as thick as the sarcasm, I admonished him sternly.

‘Were you teasing it with a stick?’ I asked. ‘Or putting your hand in and out of its mouth to impress your friends?’

Our prehistoric ancestors survived by hunting down small furry creatures, and entertaining though this pastime sounds, rabbit meat is no longer an essential part of our diet. But not wanting to be too flippant, and just in case I had missed something, I Googled rabbit-induced trauma.

Persuading my computer to Google anything other than pictures of Britney Spears is always difficult, but even after all my efforts (downloading the pictures takes up quite a bit of time), the search proved fruitless; apparently, even in a pack, even if reared by wolves, and even if cornered, rabbits will not attack humans, though get in the way of a pack of rabbits and a big feed of juicy carrots and you might be in for a stomping, however accidental.

Like stout Cortez, I could only surmise wildly that the most likely danger might arise from the rabbit’s admirably vegetarian diet; some minerals, vitamins and fibre might have inadvertently leached into the abrasion, thereby causing an unprecedented surge of rude health, which the patient’s sedentary lifestyle and cafeteria diet would be unable to sustain.

And the wise clinician will always explore the past medical history. ‘Has your rabbit ever done this before?’ I asked.