The Good Slut……

BMJ 12 August 2004 Cite this as: BMJ 2004;329:409

Call me Ishmael; I wander in the desert, eating locusts, eluding hostile nomads, and sucking on spit. I am a family doctor, I prowl in the night, perilous and alone. I meet the old and the lost, the desperate and the hopeless, when darkness is not just falling but sharpening it’s claws .But in my darkest and most dreadful hours I may call for help, for I know there is one friend who will always answer my call.

A few months ago I was trying to organise an admission for a patient with probable post-operative deep vein thrombosis. The surgical senior house officer was unhelpful: “That’s medical,” he said.

The medical senior house officer had no similar get-out clause. “Send him on in,” he said, in a tone weary with resignation and suffering; I wanted to give him a big hug.

The acute medical ward is the slut of medicine; it’ll take on anyone, anytime, and it is the place of last resort. This is a good thing, and a most honourable calling; it is a haven, a sanctuary, a place of refuge. Sometimes what a patient needs most is a warm bath, a hot meal, a comfortable bed, some company, and a few kind words, what in more innocent times we used to call nursing care. But the NHS has no overt facility for this kind of acute care, so part of the ritual is that the general practitioner then has to construct a flimsy Trojan horse of plausible medical grounds to access this care.

These lies rise blithely to our lips; our moral compromise is slow but implacable, and such invention and dissimulation become easy with practice, and so many illnesses accompany neglect that it is only a matter of choosing the handiest one.

So our admission letters are not downright lies; they are only half-truths, harmless little fibs in pursuit of the greater good.

Medical intervention, though a nice optional extra, is usually way down on the patient’s list of needs, but the patient will still have to endure the charade of being quizzed, poked, and prodded as the unfortunate junior doctor has to play the game out to the bitter end.

The Trojan horse has been wheeled into the ward, now the Greek warriors leap out and start pillaging and plundering, and sacrificing unfortunate goats to Zeus; with luck, they’ll also help out by making a few beds.

Advertisements

One thought on “The Good Slut……

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s