Wednesday, June 28, 2006


The lovely Shinga has invited me to make a submission for the Paediatric Grand Rounds next week. All at once I am catapulted back twenty some years to a big drafty lecture hall in the bowels of the "Centre of Excellence" that was St Elsewhere's. There we all were, a gaggle of fresh faced youths (75% male, god-love-us) crammed into an ill assorted collection of white coats, (strangely those destined for Honours always wore the shiniest and best fitting coats too...).

Like a christian being herded in to the Colosseum for the half time entertainment a poor benighted Brummie, often in pyjamas tied up with that frayed white string, would be prodded on to the stage for our edification, and the trial by humiliation would begin.

These grand rounds are not at all like that, and I hope to offer a worthy contribution from a GP perspective. Still I can't help feeling a certain frisson. But this is not the panic of which I speak. Oh no. I can meet even the most eminent of Professor's gaze for at least 10 seconds now before I have to blink.

No indeed. This week I have been intrigued by a juxtaposition of events here in leafy Borsetshire and the wider world as represented on Radio Four's Today Programme.

First the local. We have had a number of calls from worried parents this week. It seems we are in the middle of an outbreak. Maybe this one even qualifies as An Outbreak. It's Hand-Foot-and-Mouth Disease. For the uninitiated, and all the mums in Borsetshire, this is an essentially trivial viral infection. The illness is both mild and self limiting. But visible. And just possibly a cause of miscarriage if you happen to get really, really unlucky. Because of this whenever we get an outbreak all the nurseries and playgroups in town go into a flat spin and every child with even the vaguest symptom of anything gets sent home, only to turn up in the duty surgery for the usual advice and reassurance. The mere name of it terrifies mums though. They remember the chaos of a few years ago when Foot and Mouth disease led to the wholesale destruction of vast numbers of animals and widespread travel restrictions. I'm sure some of them have visions of us coming to drag their little darlings away to remote outposts and nailing their doors shut with white crosses painted on them as in days of yore. They all seem almost disappointed to find out that it's really not at all serious for their offspring, and indeed, scarcely a danger to the wider populace. The worst impact it has is on the time off they or another family member might need to take to cover their "quarantine" from playgroup.

Now the bigger picture. Yesterday morning the Today programme publicised a news item regarding an open letter sent by thirty eminent immunologists and public health experts calling for an end to the hype surrounding the flawed theory that MMR vaccine is linked to Autism. Later in the day they had a Doc on a talk show (? Jeremy Vine) who was herself still convalescing after contracting measles some six weeks ago. She caught it from a patient. Likely an unimmunized patient. She was at pains to point out that she had never herself encountered a case of measles before, and neither had many of those charged with looking after her. She felt unwelcome as an inpatient because she had a major contagious disease and no-one seemed to know what to do with her.

It has to be six years since we last saw a case of measles (in an adult and contracted abroad) and I too might struggle with the diagnosis it's been so long. There are classical signs and symptoms but most patients don't read the books or present their symptoms in an orderly fashion. When the epidemic hits, and as things stand it will hit, we are all going to have to relearn measles pretty quickly.

The earlier interview was well handled by the Spokesman for the "gang of thirty" but still the interviewer had the nerve to suggest that by publishing their evidence based call for an end to the "controversy" they were in some way complicit in it! So here's the thing that really troubles me. This week our workload has probably been increased by as much as ten percent by a trivial and short-lived complaint that we understand very well. When measles hits it is hard to imagine we will cope as well.


Shinga said...

There was, of course, no awareness that irresponsible reporting to the point of hysteria, is emphatically complicit in our present situation. WHO recently reported that the global scourge of measles is retreating because of the vaccination programme in countries where it has been endemic. Except for the UK where measles in on the increase.

I occasionally meet parents who think that measles is a childhood illness and everybody knows:
childhood illness = trivial.
Of course, these are sometimes the same parents who suffer from fever phobia, despite guidance from their Flea. So, my child's immune system is strong enough to run the risk of contracting meales: my child is so fragile that a high temp. demands significant clinical intervention, despite the child still playing happily and feeding well.

Is coping with this sort of dissonant thinking part of the training provided by the Royal College of General Practitioners?

Regards - Shinga

Doctor Jest said...

Coping with dissonant thinking is not formally part of anyone's training so far as I am aware.

Communication skills absolutely are, and we like to think we've become a bit better at them in the past couple of decades. But when the other side is always shouting you down with a megaphone and your "employers" have a record of telling whoppers on all fronts, it can be a bit of a loosing battle.

Doctor Jest said...

Oh, and there's the hoary old chestnut that GP pay depends on hitting immunization targets so we must have a vested interest and so can be safely ignored.

Z said...

I felt the same annoyed reaction to the Today interviewer. They seem to think that it is always appropriate to goad the interviewee.

wendz said...

I find it amazing how far medicine has come. As a kid I had just about all the 'diseases' going (and lived to tell the tale)...but my boys are so well-immunized that I defy any nasty little groby to try and take up residence..where will medicine be in another 40 years?

Doctor Jest said...

z-- I guess it's down to spending much of their time trying to get straight answers out of weasles -- er, politicians. But you would have thought they would be able to tell the difference...

wendz-- agreed. We have come a long way since penicillin and cowpox vaccination. We live in exciting times with widespread use of genomics and nanotech just around the corner. I'm just hoping some folks will still need a friendly chat and a hand-hold somewhere along the way before the boffins do me out of business....

wendz said...

Well now - for someone who was complaining to Greavsie about the use of big words on a Friday, you've got a cheek to be throwing around things like genomics and nanotech..

*Googling medical terminology*

Doctor Jest said...

I never. Honest. I was merely pondering that I had drifted too far into the realms of metaphysics in my reply and it was too long till the first pint of the evening was all. For that matter it's still too far off now, even if we did toast the Senior Partner's retirement with fizz for lunch ;-)