Wednesday, December 27, 2006

Interview with the.....

... Ostritch.

And there you were thinking I was communing with the Undead. Sadly (?) the reality is far more mundane, but before that, more pithy and urbane musings on the state of the world at large and our little corner of Borsetshire in particular.

First, no matter when the "last-surgery-before-Christmas" happens to fall (Friday afternoon 22 December on this occasion) a weird phenomenon is to be observed. The surgery, which has been thereto a heaving mass of afflicted humanity sore in need of "the tablets", is transported wholesale to a parallel dimension. Wind howls across the deserted waiting room, sporting fitfully with the tumbleweed that appears from nowhere to fill the void. The phone, till now red hot in the operators hand, forgets all on a sudden how to ring.

Every five minutes or so someone feels the need to lift the receiver just to check, but there really is nobody there. (That should probably be "there really isn't anybody there" on reflection.)

The truth is, the whole of Ambridge has suddenly found something better to do with their time than be ill, and for most of them that means packing up work early and clearing off for the Holidays. Surgeries will be like this for the next fortnight, frequented only by lost souls who forgot to get "the tablets" in good time for Christmas, those unfortunates slated to work between the two holiday weekends who find themselves too hung over and in need of an exculpatory sick note, and the odd poorly person in amongst the others just to keep us on our mettle.

Second, if you can have "second" three paragraphs after "first", (makes mental note to look again at avoidance of circumlocution in New Year, I blame the reappearance of Ronnie Corbett on the telly, so anyway the producer said to me just now..... ) the roads of Borsetshire are bereft both of fog and of traffic. The same phenomenon that has whisked off the punters has done for all the road users in the county. Every single one. Except for sad specimens like the Bin Men and me. Somehow I quite like that juxtaposition though, especially since the Bin Men probably make more of a contributuion to public health on their weekly rounds than I do day to day in surgery. (And they helped me get to work in the guise of Gritter Lorry Men the year we had the blizzards, but that's a whloe 'nother story.)

Right, now that's off my chest as it were, back to business. Ruth brings in Ben and Josh today with a bit of a cough. You see Ruth is not a believer, and so failed to bring them in for the laying on of hands last week. As a result no-one in the household has slept for three nights because the lads have had a bit of a cough.

Every ten minutes or so.

All night.

They haven't even managed to synchronise paroxysms so that's every five minutes on average. All three pasty faces the other side of the desk look a trifle frayed. Or at least the two I can see properly do. Josh has decided, probably quite wisely, that he doesn't want to see the Jesterly "Christmas Jumper" in all its resplendent glory, and so has hands clamped firmly over his eyes.

With impeccable two year old logic, Josh figures if he can't see me then he too is invisible. He is disabused of this quaint notion by the cold bell of the stethoscope making contact with his back, but so long as I remain invisible, my stethoscope can't exist and it can't be happening so that's ok then isn't it. If he believes hard enough perhaps it'll go away. And so it does, in the end, as do the fingers feeling for "swollen glands" in the neck. The ordeal is all over.

Suddenly we can all become visible again, the hands drop and a pale but cheery Josh emerges into the light.

Later it occurs to me that Josh is simply enacting something we are all capable of metaphorically in this all too literal form. We all have things we perfer not to face, and so clamp our hands tight to our eyes, only to drop them when the visit to the dentist is over, the tax return is filed or the annual appraisal has been completed. Then we drop our hands, wonder what all the fuss has been about and carry on.

Until the next time.

Friday, December 22, 2006

A merry christmas to all our readers

Well that's about it. The last surgery before the festive weekend. Four days in the familial bosom to look forward to without the distraction of duty sessions. I have a couple of visits to do on the way out, and then those last few odds and ends to shop for, after that the festivities will commence in earnest, so this is likely to be my last post before Christmas.

So far it looks like Ambridge might be "White" for the holidays only in the sense that it will still be stuck firmly in the middle of a cloud. Still, this year Jest Acres has furnished a plentiful supply of holly and mistletoe with which to deck our halls, so we are having a "green" Christmas if anything.

Thanks to all readers and contributors down the past year, and may you all have a very happy and healthy Christmas. I hope that Santa brings you everything you wish for and your festivities are as cheery as we intend ours to be.

I'll hopefully be back on or soon after 27th December, but be warned we are off to Mrs Snell's Panto in the village hall on Boxing Day so I might still be in "sillier than normal" mode.

Oh yes I might.

Still by then it really will be "behind you!".

Wednesday, December 20, 2006

A light in the fog

We have moved through eldritch and whispy. Now we are swathed. So swathed the Motorways hereabouts are at a standstill. So the morning drive this morning, bearing in mind that Ambridge High Street is still shut, was even more of an adventure than normal. I felt like the poor herbert in the TA ad from a year or two ago, careening through the woods at night in his Landy as the instructor yells for him to kill the lights and keep going.

But this is ok, because this is the week I know I am untouchable. You see some kind of Christmas magic imbues GPs throughout the land this week, and I am, as are all my colleagues, at my most beatific.

"?" you rightly ask.

I shall ellucidate.

For this week only I have supernatural powers, right up there with the best of them. My very touch can heal. My stethoscope, normaly an humble diagnostic aid, becomes my magic wand, my wizards staff, my shamanic totem....

I know this because my faithful band of worshippers tell me so. They bring me their firstborn children for the laying on of hands*. They deluge me with cards telling me how great I am. I commune with the spirit world.**

Well, alright, really they bring in little Lilly and Freddy, to be "checked", so they wont be ill over Christmas. Still their faith is as touching as it is undeserved, as though my simple scutiny this week can ward off all evil. Would that it were,so. Still a lad can dream, and as you can probably tell, I rather like becoming one of Santa's helpers just for the week.

It's one of the fringe benefits of working for the Elf Service.

* and their second, third, fourth born, yea even unto the seventh generation.

** whereas lady doctors mainly get given sherry.

( This post now appearing at Shinga's excellent edition of Paediatric Grand Rounds mates.)

Monday, December 18, 2006

The fall and rise....

... of Doc J?

The powers that be have shut the main road through Ambridge this week. As a result of their thoughtlessness I have to take a more circuitous route in to work. This takes me down roads I used to commute on regularly, but have not visited in over a decade. It also gives more time for automphalopsy*.

The first thing that strikes me is how mutable our sub-urban landscape has become. Factories that had been standing by the roadside since the 1920’s when last I traveled this road, have vanished. The manufacturing has been outsourced to the Baltic I gather. In place of the factories we have “Rabbit Hutch” housing and apartment blocks that might have graced a 1980’s Bruckheimeresque Miami harbour-front, but which on a bleak Borchester December morning end up looking absurdly out of place. I mean, who in blighty can honestly say they get any mileage out of a balcony for god’s sake, specially a balcony 0.5m from a main road. I suppose if we were slightly more touristique in the summer they might come in handy for serving cream teas to the upper story occupants of open topped busses, but we’re not, and they won’t.

Now, having digressed almost as massively as I was detoured this morning, back to the main business of the day. Traveling these familiar yet unfamiliar roads took me back ten years or so to a fresher faced less worldly wise Dr J. The practice has come a long way since then, as have famille Jest. Most of it has been good. Some has been awful. On the whole though not a bad decade. But I can’t help feeling I’m slowly morphig in to a latter day Doc Morrisey**. I find myself saying in all earnestness to punters with lurgi, “Oh yes, I’ve had that too… wonder what it is?” or “Oh yes Mrs. Snell, there’s a lot of it about” or even, “Well if I were you I’d just keep on taking the tablets. Now tell me about the old love life….”.

Still, said with a knowing smile and tongue firmly planted in cheek I reckon that makes me post-modern. So that’s alright then.

*I googled this and so far it doesn’t seem to exist so I’m claiming ownership of it. It’s my neologism till proven otherwise. So there. (And a hob nob to the first respondent to correctly attribute it’s meaning) (And no, it’s not rude).

** I didn’t get where I am today by explaining obscure seventies sit com references.

Friday, December 15, 2006

Captain Scarlet

Captain Scarlet was, famously, indestructible. I reckon I know his mum.

Freda was in this morning. She is the far side of eighty, has had rheumatoid arthritis for all the time I have known her (and a decade or two before that too). She is also inclined to be a bit chesty—the product of a few too many woodbines, a habit picked up back when Herr Hitler’s boys were trying to do for her. She’s not actually smoked now for donkey’s years, but still lives with that legacy. So much so that in the autumn she went down with an acute pneumonia.

When I visited her and told her she would have to go in to the hospital for a day or two to start the intensive antibiotics she was going to need she looked crestfallen. The thing was, she was due to go to Spain to visit relatives ten days after my visit. I promised her we would try our best to get her fit for travel, and sure enough, ten days later and after just three days on IV antibiotics before converting to bucket loads of amoxicillin and steroids, she boarded her flight and convalesced in fine style.

Today she is back to review her steroid dose. She needs it tickled up a bit she tells me. This is because her arthritis has been a bit naughty since the weather has been getting worse again. And because she is fretting about her baby, now a grown woman of fifty-something, who goes in for a major operation next week. So Freda wants to be fit, so she can go and cook her son-in-law his Christmas dinner!

Knowing the world is peopled with characters like Freda helps me to sleep soundly in my bed at night. After all with such folk to protect us surely we have nothing to fear from the Mysterons!

Monday, December 11, 2006

An open letter thingy

This comes from a few things that happened last week, kicked off by the trip down memory lane in my last post. Seeing an old flat mate who now is a GP in the Wild West of England it soon became apparent that though we are separated by more than 100 miles of geography and at least three variations in dialect, the jobs we do are essentially interchangable, and all the pressures and changes wrought on us here in Ambridge are mirrored in his neck of the woods.

Then again, on Thursday last, two colleagues and myself met up on the home-from-school run since we each have a half day. Between us we could muster more than seven decades of accumulated GP experience, and again it was interesting to see how similar our experiences were despite being in one inner city, one leafy suburban and one far more rural practice.

Also mid-week our newly elevated senior partner was bemoaning how stressful he feels the job is becoming. As he pointed out, with the trend to ever greater sub-specialization in hospital practice, secondary care medicine has become increasingly "routine" for much of the time with teams of doctors knowing more and more about smaller and samller areas of expertise, but leaving the patient as a whole somewhat in limbo whilst they ponder all the implications of a given condition on their one tiny area of interest-- and as often as not quickly discarding them when it became aparent that there was none...

The final thing that crystallized this post was the realization (epiphany being far too grand a word for the accompanying sentiment) that we were all, severally, a bunch of miserable gits, old before our time. So I have a question to pose, but before I do I want to set the scene.

As jobbing GPs we have always been taught to look at the whole person and not just the initial symptom presented. To use a seemingly banal analogy the consultation of a mother bringing a child with a sore throat will play very differently if the mother is 16 than if she is 36, if an older sibling has died of flu, or suffered with leukaemia, if granny lives two doors down the road or (as is more often the case these days) in Spain, if the child in question lives in a mansion or a refuge and so on and so forth.

Embedded as we are in the community, with a longitudinal view of patients and their families, the surrounding communities, cultures,and prevailing conditions, we feel excellently placed to take such matters into account and deliver the best care to every patient that presents to us. And yet, down the years we have steadily seen that embedded experience diluted, first by combining together to provide out of hours cover from co-operatives, then by loosing it altogether to faceless monoliths supplied by PCTs. There has also been a trend to sub-specialization within General Practice so that patients are increasingly filtered into little mini clinics for asthma, heart disease, warts, family planning..... you get the picture.

I would still argue that our attempts to hang on to the last vestiges of "family practice" can make us more effective in the long term. By "being there" through the minor ailments of childhood, through adolescence, childbirth, chronic disease and even palliative and terminal care we develop relationships with families that allow us to view them in the context of their "back story" and them to see us against the background of our shared triumphs and adversities.

This is the "added value" of traditional "General Practice". The perceived wisdom from on high is that this "value" does not stack up against the consumerist agenda of instant access, speedy treatment, and "quality" measured as tick box questions about smoking and ethnicity for all and registers of obesity with no evidence based intervention to apply once the registers are gathered. If it can't be counted, the present regime wants nothing to do with it. And if you have to wait for it then it must be a poor service that is being delivered. All that's needed, they contend, is IT access and a "Doc-in-a-box" available 24/7.

So the question is this, are we right to assert the values of "traditional family practice" or should we just get over ourselves and embrace the brave new world?

Friday, December 08, 2006

A la recherche du temps perdu

Last weekend the Victorians took over Borchester. Yes, once a year the city gets whisked back in time a little over a century, like a latter-day bakwards Brigadoon*. The astonishing thing is that they-- the Victorians that is-- seem to have managed to cope with the exchange rate and decimalization very well, so hardly any of them expect to be paid in groats for their tin-plate toys, olde tyme candies, organic free range tofuburgers and the like.

Oh, and hardly any of them say "Lawks", "Dearie", or sing songs telling of heart-rending poverty and privation to plangent melodies. They do still mostly smell of gin and mothballs though.

Still on the plus side they seem to have managed to leave behind the cholera, smallpox, rickets and such, and hardly any of them perform ripper-style atrocities.

Which makes you stop and think just how far we have come from the days of high infant mortality, tragically short life expectancy, the work-house, and rampant untreatable infectious diseases. (Although that last one is looking to rear it's ugly head again as we speak).

One other alarming feature of the Victorian invasion is the magnetic effect it has on little old ladies from Wales. Indeed, from empirical experience I doubt if there was a woman over the age of fifty left in the Principality this weekend as they were bussed in to Borchester for the festivities in their droves. I'm guessing they find some of the "new-fangled", "modern" contraptions the Victorians have to offer quite a draw.

Later on this same weekend we had the honour of being invited to a friends Significant Birthday Bash. At this lavish extravaganza (first Jesterly encounter with a chocolate fountain) we got to see fomer flatmates not seen for upwards of two decades. There's something reassuring about seeing a marquee full of "middle-aged" folk still thrashing about the dance floor like the teenagers we all were. Although, looking around at our teenage offspring's reactions, they seem to have found it less so.

After all this excitement it was something of a wrench to have to come back to work in the trenches again, but I get the feeling we have kicked this particular feastive season off in fine style (and that's with no more than this passing reference to our Friday night trip to the Nutcracker which got the whole weekend started). So, sorry if it took me a while to recover, but normal curmudgeonly service will now be resumed.

Now, how do you go about getting a humbug under a chocolate fountain then....


* might need a few more "g"s or "d"s here?