Monday, May 08, 2006


Monday afternoon is asthma clinic. All is going well. Everyone can remember what inhalers they use. Most can do their peak flow ( a hi tech blowing test) without dissolving in fits of coughing. Many can work their inhalers properly AND seem to be managing to take them regularly and correctly at home. Little things I know. But enough to make me happy

Then in comes old Joe Grundy. He's got bronchiectasis as well as asthma. This means he gets chest infections at the drop of the hat and coughs up great buckets of phlegm even when he hasn't actually got an infection. (Welcome to the wild and whacky world of the chest physician folks). So first we get an in depth description of his secretions. (Glad I didn't go with the guacamole at lunchtime now).

Next we get to review his asthma (not too bad despite the cigarettes- "that purple ihnaler really helps, I don't cough up half so much after a fag now doc"), and his inhaler technique, which remains idiosyncratic, but plainly works for him....

He agrees to try to cut down the ciggies and I agree to renew his repeat prescription. We mutually agree to do the whole thing over again in six months. Then he puts the boot in.

"Ere Doc, you know them stomach pills you gave me last week?"

I do. They're called PPIs . Very good for ulcers, acid reflux and the like.

"They worked a treat. I can eat bacon and eggs and curries and such no problem now. Thanks a lot!"

Mens sana in corpore sano, eh.


greavsie said...

So being a Doctor isn't a wheeze then?

Moof said...

That sounded very discouraging ... *comfort* ... 0.o

Doctor Jest said...

Mr Greavsie sir-- I try to remain phlegmatic in the face of it all.

Moof-- more irritating if anything. But he's such an engaging character he engenders more wry amusement than anything. Thanks for the kind thoughts though. Always appreciated.

Potentilla said...

Certainly seems to me that he scores in the mens sana stakes. He's old and sick and means to enjoy his life as much as he can. Do you think that's a bad use of medicine? of taxpayers' money? Does he have some sort of duty to make himself miserable by giving up fags and curry?

This is a genuine question; I'm interested in related philosophical issues and I would really like to know what you think..

Doctor Jest said...

Potentilla-- Good point well made. Traditional Anglo-Saxon medical practice has tended to the paternalistic. We tell the punters what to do and they'd better bloody well go and do it or else.

I know other cultures do things very differently. I heard a Prof of GP who had spent a lot of time in Holland tell of the Calvinist tradition (IIRC) which frowns on such paternalism. Dutch GPs would NEVER tell a patient they must or indeed must not do x or y and only treat the problems brought to them as best they may.

I tend towards a middle way. If Joe is hitting himself on the head with a hammer and comes to me with a headache I will try to point out to him that the hammer might be part of the problem, then treat the headache. Ditto the fags and curry.

I'm more than happy to continue to treat in the knowledge that he has made an informed choice re the above.

Abstinence might or might not make him live longer. It almost certainly wouldn't make him happier. But it might just help his wheeze and heartburn more than my imperfect meds....

Also I may have made him sound older than he is. Retirement age and life expectancy thankfully do not go together so these days I would not regard 60+ as in the twilight of life and Joe just barely qualifies for his bus pass.

Potentilla said...

Thank you. As someone who is most unlikely to make it to a bus pass, and whose father died last year of decompensated alcoholic liver disease causing various people to opine that people like him shouldn't be treated free on the NHS, I'm interested in the various aspects of this issue (and posted on it here

I do understand that it's a doctor's job to make sure people can make informed choices; I'm actually more concerned about the govt's paternalistic views than the medical profession's.

Doctor Jest said...

Whatever "they" say no-one should EVER be denied access to health care.

There is no case for failing to treat "self-inflicted" illness because of some warped "moral" judgment. We cannot know what has driven some people to the choices they have made.

And for society to make money of the back of Alcohol and Tobacco and then to try to suggest that users should be denied equality of access to healthcare would be utterly reprehensible.

Once a truly informed choice has been made we have a duty to respect it, but not to allow it to stay our hand in offering treatment where available thereafter.

I'll put the soapbox away now. Sorry to hear of your travails.

Sadly paternalism is what Government seems to be all about these days. Still it's probably all for our own good ;-(