Monday, November 24, 2008

Help wanted.

Twice this past week I find myself somewhat at a loss to see a way forwards for the folks on the other side of the desk. We appear to have strayed into “irresistible force vs. immovable object” territory and I’m not a all sure how we are going to negotiate it. Allow me to illustrate.

Case one:- “Loose lips….”

Enter Brad’ and Ange’ (names as ever changed to protect the …. you all know the rest). Ange’ had her three yearly cervical cytology done a few weeks ago and the result wasn’t exactly normal. There’s a whole argument to be had about the merits of the whole cervical cytology screening programme, but that’s not for here. The point was that her result, for the first time since she began the screening some fifteen or so years ago, was “abnormal” and showed “borderline changes” in the cells. According to guidelines we need to repeat the sample in six months and if all is well she can move on without the need for intensive investigations, but in the meantime she has to live with the ticking time-bomb of “abnormality”.

And then some Smart Alec at work says to her, “Of course that’s caused by a sexually transmitted disease you know!”

So Ange’ rushes home in an histrionic fervour, beards Brad’ in his lair and starts demanding “How could you?”

The upshot, an attendance to the Ambridge Surgery. We go over the whole Cervical Cytology- HPV- Cellular changes- Cervical Cancer, discussion, but in all honesty our grasp of the precise natural history of this process if hazy at best. They have been together for years, but both had partners before committing to one another, and Brad is quite prepared to swear on all that is holy that since then he has been happily monogamous. Now I accept as a male GP I might be unwittingly biased, but his body language, and indeed the mere fact that he has attended with her on the day, leave me inclined to believe him.

We discussed the fact that despite their long term commitment, should the anomalies in her cells prove to be related to HPV infection, that doesn’t automatically call her man’s fidelity into question, but Ange’ remains visibly unreassured. In the end I have to suggest they seek help from a relationship counsellor as this one chance remark has caused such an apparent rift.

Case 2:- “Love me love my cats”

Sid comes to the chest clinic. He has a cough that has been going on for years. It’s worse when he tries to run, and it’s been deteriorating since Joelene bought her kittens a few years back. He’s tried all sorts of inhaler regimes down the years and none quite gets the job done. So now he’s convinced it isn’t asthma he’s got at all. After all surely the inhalers would have kicked in by now. (I keep telling him not to call me Shirley!)

O.k. so they help him after a run, and they reduce the cough to a minor irritation rather than a constant nuisance, but really if it were asthma they’d have sorted it out by now, Shirley?

We go trough the history again. We look at his peak flow readings, before and after inhalers again. All point to the inescapable conclusion that he has obstructed airways, that get better with inhaler treatment.

In short, Asthma.

So there.

Worse yet, it sounds highly likely that Sid has an allergy to the little bundles of fluff that are now full grown cougar wannabes, who lord it about the house, lolling over sofas and beds, shamelessly indulged like the child substitutes they so plainly are by the otherwise empty nested Joelene. When we have the temerity to suggest we test Sid for cat allergy he ruefully shakes his head—“She’s already told me the cats aren’t going”.

So we try another asthma treatment.

I wonder, is Kofi Annan busy right now?

Monday, November 17, 2008

St Elsewhere's?

You know your appraisal’s going wrong when your appraiser says “You could always think about doing something else…”

After last year, when a commenter rather chided me over the whole “buzzword bingo” concept of appraisal, I decided to do this one cold. This might have been a mistake.

I thought I had prepared my case and supplied the necessary evidence to back up my professed competence, but this year’s appraisal felt somehow so much more joyless than any hitherto, and my appraiser (a new one I’d not met before the day) seemed less interested in the materials I had provided than in her own agenda, namely whipping me in to shape for “revalidation”. It probably didn’t help that I was incubating my annual dose of low grade but highly irritating lurghi come the appointed day. Nor did it help that I had spent forty five minutes completing a twenty minute journey to my place of execution… er appraisal. The fact that the day had not afforded an opportunity for a second cup of Java or any hobnobs at all probably sealed my fate.

As a result I accept I might have come across as a little grumpier and a tad less engaged than I might normally. However it also seemed that the appraisal agenda has changed from a formative mentoring relationship to one of challenge and compulsion. I’m not entirely sure on that point, and accept that I performed badly on the day, but with the benefit of a fortnight of introspection after the fact, this experience was so at variance with the five previous encounters that I await the next with no small measure of trepidation.

And the really sad thing is I’m not at all sure I could, or would want to do “anything else”. I can tell you that next year the bingo will definitely be back on the agenda though.

I’m sorry it took a while to regain my normal equanimity after these events, but I reckon I’m back now, and certainly in no mood to go elsewhere.