Wednesday, April 30, 2008

Back in the saddle...

In the past two days I have seen patients aged from 0 (well ok, 2 weeks) to 102 (with her card from the Queen, sent on her centenary, still proudly on display in her flat). I’ve tried to help a number of young women to avoid unwanted pregnancies, and begun the process of helping one couple who are struggling to make a very wanted baby. I’ve held discussions with young mums about the development and well being of their infants, and one long and heart-searching discussion with the septuagenarian son on a nonagenarian mum who has become non-responsive in a nursing home and looks likely to be entering what will be a short and hopefully painless final illness.

I have seen two dozen sore throats, a handful of bad backs, more than a handful of depressed folk (two just coming back from the brink of self-immolation). I have talked with one chap about a necessary early retirement. I’ve counseled the family of a man undergoing investigations for a scan anomaly which just might be cancer, but is more likely to have been the radiological equivalent of a hair in the gate, ( “yes everything is very probably o.k. but we have to do a scope examination to absolutely sure. Right now the most we can do is hope for the best, but plan for the worst”. A platitude that reassures no-one, but at least the explanation of the process seems to have helped a bit).

I’ve made three routine home visits and two urgents (one of the latter requiring an emergency admission to hospital after a “min-stroke”). I have five referral letters dictated and waiting to be typed. I’ve petted two dogs, three cats and placated a half dozen toddlers.

A couple of my patients this past two days appear to have been left with the impression (quite wrongly) that I can do magic. A handful have left me in no doubt that I am a waste of space and not nearly as good as that nice Dr Neighbour, “why does he always have to be on holiday when I need him so I get stuck with you?”

All in all it’s been a pretty average couple of days, but it feels good to be getting my mojo back. I have no idea where it went, but right now I don’t care, and you’d be pretty hard pressed to persuade me I don’t have the best job in the world.

Except maybe for a Ben and Jerry’s Ice Cream Flavour Tester.

Monday, April 28, 2008

Emergency Service?

Gentle readers, I have to confess to being a bit perplexed by this next diagnostic conundrum. I’m hoping there are some of you out there amongst my varied readership who could help me to unravel it, but before I get going I have to issue a tiny health warning, in that the subject of today’s enquiry is of an hem-hem, Adult nature, as they say. (Well they do if they are Nigel Moleswoth at least). Needless to say, given the usual inane tone of these meanderings, it might not attract a suitably, hem-hem, adult treatment, but then that’s not what you all come here for is it?

In a nutshell the problem is of a somewhat intimate nature, in that a young lady attended surgery last week seeking help with contraception. She was asking for a handful of “morning after” pills*. It seems that her previous GP had hit upon this unusual approach to family “planning” after she presented her rather delicate problem to him a while ago. Perhaps it would help if I explained why such an approach is at variance with accepted practice, before I go on to detail why it had been chosen in this instance.

In effect the “morning after” pill is intended as a single shot treatment for an isolated indiscretion, or failure of other method (principally condoms). To require several such pills suggested an intention to serial indiscretions, which, as health care professionals, causes us some pause for thought. So I had to ask the poor girl why she needed such a “Russian Roulette” method.

It transpires that she has never really been suited to either of the usual varieties of pill through adverse effects such as significant weight gain, or troublesome skin changes. For that reason she had also fought shy of implantable or injectable methods using similar hormones as their basis. As a nullipara (a lady yet to deliver a baby) she is not a candidate for a “coil” either, and, as any fule kno, caps and the wretched “femidom” female condom are about as effective as the old fashioned “hot bath and Gin” method and as spontaneous as a line of Pinter dialogue. And so she and her boyfriend have been diligently trying to use condoms, but about one time in three they burst and she finds herself in need of emergency contraception in the form of the good old “morning after” pill.

So here’s my problem. She and I are both aware that certain substances have a deleterious effect on rubber that can occasion such failures (baby oil being chief amongst these) and she is quite certain that there is no risk of this. She reports that her boyfriend is just “too big”.

Now, having spent many a late night in Doctor’s Messes the length and breadth of the midlands in my formative years, I watched quite a lot of late night Channel Four youth TV. You could guarantee that once every couple of weeks or so some drunken idiot would appear on “The Tube” “The Word” or some other hip and trendy show with “The” in the title, and perform his (yes they were always plug ugly, synaptically challenged herberts) party piece, namely the unrolling of a Rubber Johnny over the top of the unappealing visage to just below the oft fractured hooter. Thereupon said herbert would inhale though his mouth and exhale through his monstrously deformed nose, inflating the aforementioned prophylactic to roughly the size of a London Bus, before it explosively decompressed, sadly leaving the perpetrator unscathed though now adorned by a slightly slimy latex “Alice Band”.

So now I’m wondering just what this couple are doing to occasion such a spectacular failure rate, unless it is just that Boy Friend thinks that the technique described above is the approved method of use?

* for the uninitiated the "Morning After" pill is a monster dose single shot treatment of an oral contraceptive that can be taken anywhere up to 72 hours after an incident of "Unprotected Sexual Intercourse" ** so "Morning After" pill is a bit of a misnomer. Oh, and it used to be two doses of same taken at a twelve hour interval which made it even more so, though not now that both doses have been amalgamated so the name is at least half right these days....

** the acronym is UPSI. There is a trend for naming little girls Daisy round these parts, so I'm looking forward to being able to record my first "UPSI-Daisy" in around 15 years time...

Tuesday, April 15, 2008

Moan grone droan....

Soul searching is a wretched occupation to be sure, and yet sadly there are times when it becomes unavoidable. For me the past few months have been just such a time, and the truth is I'm far from happy with the conclusions I am reluctantly drawn to make.

You see folks, before you stands a creature as obsolete as the diplodocus, the marsupial lion, the dodo. It appears the job I spent almost half my life training for, and the remainder practicing, is no longer relevant. Family Practice, at least the sort of practice I understood as such, is dead.

The thing that hurts most about this is the knowledge that I and my colleagues have been at least complicit in, if not active proponents of its demise. Never has it been more true that good intentions make for the poorest choice of paving. It matters little how we got here, except perhaps to historians who in years to come may pore over the all too brief social experiment that was the post war Labour administration's establishment of the welfare and national health systems that now lie in tatters. It's what we do next that really matters. So for what it's worth, and for as long as I am able, I shall continue to ply my trade the best way I know how to any who wish to avail themselves of my services.

But with an uncaring, pettyfogging, beureaucratic civil service under a runaway political class on the one side, and an increasingly litigious, narcissistic, solipsistic populace on the other, I'm starting to feel more than a little like Han Solo in a trash compactor.

And the walls keep on closing in.