Blue Blood; how I was deprived of my royal destiny…

BMJ 03 December 2008

As a baby I was of royal blood, closely related to the Dauphin—close enough, like Sarah Palin, to see the Russian royal family from my house. Unfortunately, on the day I was presented to the adoring masses, the ceremony was hijacked by the Evil Fairy, who stole me from a life of Parisian splendour and decadence and for good measure chucked in the vices of Greed, Lust, Envy, Gluttony, Sarcasm, and, finally, just to prove that the devil has all the best jokes, Bestiality.

Fortunately, just before I was spirited away to rural Ireland, the Good Fairy turned up. Unfortunately, because she was so late (apparently Cinderella had needed emergency contraception and was too thick to realise that it was available over any pharmacy counter), she couldn’t restore my rightful place among the crowned heads of Europe, nor were there any other decent presents handy. The only gift she had left was Sloth, which she reckoned would protect me from the worst excesses of the other vices, all of which need a bit of enthusiasm. Thanks for nothing, lady, I might have said, now sod off back to your gingerbread cottage.

Which explains why I have always been seriously lazy and chose general practice as a vocation. Dressing in tweeds, smoking a pipe, walking the dog, sitting back in a comfortable chair listening to people drone on and on, idly tootling down country roads gazing speculatively at the sheep: it was the perfect career for me.

But not any more, because family doctors are getting ever busier, partly because of a mushrooming bureaucracy and partly the result of the inexorable advance of scientific knowledge, which sometimes trickles down eventually to us. For example, 15 years ago patients with atrial fibrillation were put on digoxin, and that was more or less the end of it; but now that we know atrial fibrillation increases the risk of blood clots, they need warfarin, with all the associated supervision it demands.

And with every advance it’s not as if something drops off the back of the bus to compensate. We can’t stop seeing kids with upper respiratory tract infections, varicose veins still need to be referred, and cardiac risk factors still need to be modified. The workload is ever expanding.

I expressed my frustration to my Auntie Mamie.

“C’est la vie, your majesty,” she sympathised.

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