Oi, stop chucking all them bloody spears!*

Right now I'm feeling a bit like Michael Caine playing Lieutenant Bromhead in Zulu. The first wave of the attack has passed and the troops are seeing to the revetments and mealie bag barricades in anticipation of the next wave. Happily thus far, the hospital isn't on fire.

Now you're all sitting there wondering what the hell I'm rambling on about. That's o.k. Sometimes I wonder myself. But no, this time there is a point, honest.

I'm talking about the "Swine Flu". The reason I haven't so far is because early on in the pandemic we were a bit busy preparing, like Michaels tiny band of Red Coats, piling up the barricades. Then it all went a bit berserk, with assegais flying about all over the place... er, the phones ringing off the hook, mainly with the "worried well" but in amongst these a fair few who were poorly. Due to an appaling coinicidence of timing Ambridge was hit with a bit of a summer cold bug just as the flu hype was really getting going which didn't help. In the end we peaked with something over 50 flu related calls a day in addition to our normal workload, which doesn't sound a lot until you figure that's three full additional surgeries worth, with each call needing at least ten minutes to triage and advise, and with a number ending in additional home visits.

Just when it looked like the dam was about to burst the National Flu Line, which had been promised, then posponed, then rushed into service anyway, started, and the calls went away, almost overnight. Then I went on hols, and now I'm back and all is calm again. The only snag is they tell us to expect it back in the autumn. Perfectly timed to coincide with the expected seasonal flu taking off. Since we have no tool for discriminating between the two, things might just get exciting again soon. Especially since this latest outbreak has rammed home to the whole contry that Flu is a significant and occasionally fatal illness (which it undeniably is), and also that it is "treatable" with Tamiflu (which is, sadly, far from true).

So here I sit, and just one question remains. Is it time to learn the words to "Men of Harlech" then?


* Rather disappointingly he never actually said that in the film, but I tend to the view that he should have ;-)

An open letter to the rt hon Alan Milburn MP

Dear Alan,

I can call you Alan, right? After all, in our egalitarian, best of all possible worlds, society I’m allowed. No glass ceilings here eh?

What’s that you say, disproportionate numbers of professionals come from moneyed backgrounds? And I’ll bet it’s more now than it was a few years ago. And I bet it’ll be more still in another few. And why? Well it’s obvious isn’t it? The universities are all shameless elitists who have it in for “ordinary” kids like you and me. They’ve erected this “glass ceiling” of yours to keep us in our place, yes?

Well no actually. You did that. You, with your failed policies and your failing government. I notice you had to slink away from health a few years back after wrecking that, and now you want to have a go at higher education. Well heaven help them. You see they didn’t put the ceiling there. You and your cronies did that all by yourselves. Whilst you were collectively milking a crooked system that “froze” your pay, quite wrongly I might add, and made up for it by doling out the swill in the expenses trough (and no I nether know nor care if you personally were implicated, this is satire and not libel), you thought it would be a good wheeze to introduce student loans and tuition fees.

Worse, yet, in your anodyne “no-failure” “non-competitive” school system you devalued the grades awarded in the bizarre system of GCSEs that teach pupils how to sit exams, not how to acquire knowledge. Now the universities, faced with a torrent of straight A students, have to find other ways of selecting the brightest and best. Applicants need at least a Grade 8 instrument (but we don’t do music or instruments in school), a Captaincy of a County XV or XI (but we can’t do rugby or cricket—we sold the field) and a plethora of other qualifications or aptitudes beyond what school can offer in normal hours (but we only have to teach the national curriculum).

A medical student qualifying this year will have, on average, a student loan debt approaching £50,000, sorry, didn’t you quite get that, I said FIFTY THOUSAND POUNDS. Lawyers and accountants might owe slightly less, but will still need to obtain post graduate qualifications in order to actually pursue a career in their degree subject, which they will pay through the nose for, with far less guarantee of a job at the end because you’ve blown all our money fighting “terror” and shoring up failed banks. Overall the medics have it easy don’t they.

So how dare I, a privileged member of this moneyed elite dictate to you, a veteran class warrior and striver for equality? Well you see my roots are about as working class as you can get. I was lucky enough to get to a grammar school, and to have grandparents who wanted badly enough for me to be the first of my family to go to University. The same is true of three of my four partners. You’re right, the students I teach now all have at least one professional parent, but it’s not their fault, and it’s not their University’s fault either.

This is the world you made. I imagine you all started with the best of intentions, but you’ve screwed up so badly it almost defies belief. Still you’re not in it for the long haul are you? A few soundbites and then it’s on to the next brief, or the wilderness of opposition where you can say what you like and damn the consequences. Or if it gets too hot again, back you can go to the bosom of your family. But if I were you I wouldn’t spend too long mulling over my dubious achievements when the time comes, or I might end up very tempted to take a long walk off a short pier.

Resurgam!

To paraphrase Arnie. There's a bit too much Real Life going on right now so don't expect much for a month or two, but I aim to be back soon as I can.

Honest.

Trust me.....

The adventure of the midnight feast.

Lunchtime sees and urgent request to visit an old friend, put in by the District Nurses. When Nurse Gladys visited him this morning his blood sugar was through the roof. Not good. Especially since he's just out of St Elsewhere's after an op for diabetic complications. So I don my deer-stalker and round I zip, expecting the worst. The last time we did this I ended up having to admit him to the hospital, culminating in his surgery, a three month stay on the ward and a radical overhaul of his treatment.

Today couln't be more different. He's fine. We repair from the dining hall to his new flat in the poshest warden controlled accommodation in Ambridge (another consequence of his recent admission was the move here) for a private chat. He hasn't felt so well in ages, no symptoms to suggest any acute illness that would account for his sudden surge in blood sugar. His appetite is fine. His chest quite clear. No evidence of urinary infection, Swine Flu or other attendant lurghi whatsoever.

"So why," I gently probe, "the high sugar this morning?"

There's a pause. A pregnant pause, where the pregnancy is headed for the delivery of triplets.

"Well," he owns, finally,

"You see,

It's like this....



Last night I had a craving for the biggest bag of chips I could get. Lovely they were, all smothered in salt and vinegar. Just the job!"

Then he grins.

I nag him half heartedly about watching what he eats and then we chat about the cricket for a while.

He's going to try to be good again now, and Nurse Gladys will watch his sugars for me.

So. Another mystery solved, and yes, it appears the answer was alimentary. Now, where's my Meerschaum?

Just passing....

It's not much fun being eighty. Or so says Eric. He's just had a spell in hospital. Nothing scary. He thought he'd got a tummy upset, but it turned out to be constipation.

(When you've been bunged up for long enough you get a thing called overflow, which makes it look like you've got diarrhoea-- and that's the last we'll hear on that subject today if it's o.k. with you)

Just before he went in I'd had a visit from Doreen, Eric's neice. She's been looking after him since her aunty, Erics wife, died eight or so years ago. Every day, rain or shine, high days and holidays included, she's been calling on him morning and evening, cooking, cleaning and generally fending for him. She's all the family he's got left, and so it falls to her.

She had called in to say she was getting worried about him. He was a lot more cantakerous than usual, and had taken to stopping in bed for hours on end, refusing to get up. We had agreed that I would find a pretext for calling on him-- just to give him a bit of a check-up. Under no circumstances was I to mention that Doreen had been to see me. Then, the day before the appointed "check-up" visit, he went and got himself admitted.

In the end it's made my job a lot easier. Since he's had this seemingly trivial problem sorted out he's been a lot better, but he still greets Doreen every morning with a cheery "'Wish I was dead!" She's nearing the end of her tether with him and we're going to be needing to find him a lot more support soon, if only to preserve her sanity, so having a pretext to do a review visit on discharge was too good an opportunity to pass up.

Today we've sorted out his med's and he's agreed I can call again to see how he's getting on in a couple of weeks. In her absence he can't sing poor Dorren's praises highly enough-- though I'm sure it's never occurrred to him to actually tell her to her face. She's calling back later in the week to see how I got on, so perhaps I can do it for him-- though I mustn't let on to him that we're talking. He's not quite ready to think about letting anybody else in, but if Doreen can be persuaded that she could start letting him know it's time for her to pass the baton on, he just might be. Before she goes to the wall for preference.

It's a complex web to unravel, and none the easier when none of us can articulate half of what's needed, but if we get it right Eric might just be a bit happier to carry on living for a bit yet, and Doreen might even get a chance to start.

Lucky I was "just passing..." Eric's gate this afternoon ;-)

Just another day at the office...

Sometimes you can go for months without incident. Other times, a bit like London Busses, everything comes along at once. Seems we’re going through one of those phases in our neck of the woods. Thankfully, thus far the “Flandemic” has not lived up to its billing.

Yet.

We expect the next big scare in November or December, unless something quite bizarre happens in the interim. For now the daily email updates are moving to once or twice a week, and the planners really do seem to have a strategy in place. Whether the plan will survive more than half the work force being laid low themselves, or kept at home looking after kids/ elderly relatives who cannot care for themselves, remains to be seen. Still there is a plan.

No, this morning saw a string of genuinely troubled individuals facing potentially or already determined life threatening illness. Once again, by mid morning the surgery was more than an hour adrift with no prospect of catching up. After three patients already watching the sands of time draining from their own personal hourglasses at an alarming rate, came a mum bereaved not once, but twice in the space of six months. Her distress was etched almost bone deep on her face, and there was absolutely nothing to say except “hang in there” and “you will survive this”. I’m not sure if I was saying this for her or for myself to be honest, but after half an hour she was cried out enough, for now, to keep putting one foot in front of the other for a bit longer.

After a ten minute pause, and a half a bucket of Java, we got the show on the road again, and the rest of the day passed without incident. The poor souls who had had to wait around in our waiting room with not even drying paint to watch for amusement (all diversionary materials having been carted off and incinerated to remove possible vectors for the flandemic), were amazingly good natured, and by mid afternoon there was more laughter than tears accompanying the ebb and flow of the afflicted coming trough the hallowed portals.

Still not a day I’ll be forgetting in a hurry, or wishing to repeat any time soon. But I can’t help thinking, for all that, that I’m the one who’s got it easy here.

A visitor from the future...

Earlier this week I met Yuri for the first time. His record states he’s been in Ambridge for nigh on five years, but so far, after an initial attendance to register, and a couple of visits to Dr Neighbour for minor ailments, he’s not troubled us at all. Looking at him, it wasn’t hard to see why. It’s not that he’s particularly tall, but he’s certainly solid. The urban combats, spetsnaz style black and white striped t-shirt and high laced paratrooper boots certainly created an impression. Then there were the bulging muscles. Yuri hasn’t so much "built" his body as hewn it from living granite. His biceps put the rather weedy Jesterly frame to shame, and the suppressed aggression he exudes suggests that one false move and he could snap my neck like a dried twig. A long dead, especially brittle twig.

Happily, our own little corner of blighty hasn’t yet succumbed to the attentions of a Ray-Ban shrouded oligarch and his own private army. Yuri just came here to work, and to carry on his very impressive hobby lifting ludicrously heavy things for fun, and the odd bit of bag pummelling. Sadly, now he’s been earning for a bit, he’s found himself seduced by the powers of the Dark Side. A "mate" at the gym introduced him to chemical supplements—hormones to you and me. Androgens and anabolics.

The only trouble is, after six months of this he’s been getting some chest pains, which have him fretting. Still he’s been for an EKG back in the Motherland, and it was normal, so he’s a bit less woried now. I tentatively prod where he says it hurts. I could almost swear as I jab his left pectorals there’s a clank. I foolishly suggest we try to provoke his pain with a few resisted movements starting with his shoulder. I cling on to his elbow and ask him to lift it above shoulder height as I press down. He lifts his arm and my feet clear the deck by a good couple of inches. There’s not even a flicker of discomfort.

I decide against asking him to do the reverse move, pressing down with the elbow point whilst I try to prevent him. I value my spine, and like it just the length it is. It helps hold me up.

Still after a bit more of an exam we decide the pain is most likely a minor strain. I prescribe him some 3-in-1 and a referral to Cyberdyne Systems if he doesn't get better. Steroids, it appears, don’t do much for the 800 Series Terminator. Still, I imagine he'll be back.

Credo

Witnessing wilful self-destruction is never easy. Watching someone plumb the depths of alcoholism, or push the oxygen supply aside to light up with hands made uncontrollably trembly by the drugs needed to keep breathing because of the damage that same act has inflicted down decades is a living hell for those charged with care of loved ones so afflicted, and a kick in the teeth to those that try to treat them.

It’s often hard to take a step back and reserve judgement. But we are not them, we’ve not seen what they’ve seen, or done what they’ve done. We all have our vices, (Hob Nobs might spring to mind perchance) and we all sometimes take a road we know we ought not, just "to see what it’s like". Fortunately for many of us, we get turned around before a wrong turn gets us hopelessly lost, and that can give us some empathy for those less fortunate.

The thing I’m finding more difficult right now is finding that same empathy for those that opt to take a wrong turn on purpose. This winter Blighty has seen a Mumps outbreak. Most of the victims are young adults who were born a year or two too early to be caught in the initial MMR campaign of the late 80s. Some have been children held back from immunization because of a false fear placed in their parents minds by a tub thumping campaign based on widely discredited science about a supposed danger form the combined MMR vaccine.

The fall out from this was hopelessly bungled by the same politicians that told us BSE could never affect humans and by a scientific and medical establishment that failed to articulate clearly enough the counter argument. In the first flush of controversy it is easy to understand why some parents opted to hold back, but we are still finding MMR uptake rates lower than they need to be after all this time, and whilst I’m usually the first to champion the rights of the individual, I’m a little less keen on the right of the individual to remain wilfully and dangerously uninformed. Especially when it is not they, but their children who will bear the brunt of their decision.

In my time in Ambridge I’ve also witnessed patients cut off from family and community for an act so seemingly trivial as accepting a life saving blood transfusion, on the grounds of religious dogma, and others choosing to die, or being condemned by relatives to, for want of the same. I’ve also witnessed patients with curable, or at least remittable malignancies place their faith in crystals and carrot juice rather than hospitals and medicine, and have to endure unnecessary agonies and speedier exits as a result, all through some blinkered perspective that classed all allopathic medicine as bad because they had a bad experience once with Dr X or Hospital Y.

Mankind truly is everywhere born free, but some make pretty odd choices for their chains, and their blinkers.

Dogging?

As I traversed the Ambridge Gyratory System* the other morning I was struck by the contents of the large estate car in front. Two gormless lop eared Labradors gazed benignly out at me, until the car hung a left and disappeared down the ramp to the Councillor Dan Archer Park and Play Area.

Walkies, it seems, have become "bit of a drivies". Man's best friend no longer has to turn out attached to a leash and walk to the park before getting to zoom about like a lunatic chasing a tennis ball. Now Fido can expect to be chauffeur driven there and back again, and spend ten or fifteen minutes wheezing about after some fuzzy, squeeky monstrosity from the pet shop that looks like a failed genomics experiment and has none of the roll or bounce potential of the good old b-a-l-l (sorry felt the need to spell it out just in case any dogs were listening).

I worry slightly that as soon as they develop a playstation controler adapted to the canine paw, instead of a drive to the park, poor pooch will be parked in front of the doggy version of Doom or Quake, and left to get on with it. It's no wonder our pets, like their owners and their owners kids, are facing an obesity crisis.

There's just one word for it really.

Barking.


* The ring road hemi circumnavigating our fair town, not the 1970's Jazz Fusion Combo of the same name.

Clock watching

You might wonder why, should you ever have cause to see a personal medical attendant, you spend ages sitting in a waiting room , browsing decade old National Geographics and the like. Perhaps a quick snapshot of this afternoon’s surgery will help explain.

15.00 Enter first patient. Young adult male. Suicidally depressed and in crisis. After a bit of a chat, we manage to tease out the principal cause, agree a management, with antidepressants and the safety net of a ring back any time offer, and fix a two week follow up appointment.

15.30 Enter second patient (appointment 15.10). He’s been drinking a lot lately—just fluids, not alcohol, after all he is only 14—and he has to get up a few times a night to pee. No he hasn’t brought.. but yes he can do a specimen. We find a pot. He pees. The stick shows he’s passing glucose syrup. We find a glucometer and prick his finger. His glucose is 24, or roughly four times normal. We agree he should go to the hospital and get started on insulin. This needs a phone call to arrange.

15.55 Enter third patient (appointment 15.20). She’s worried. She had a car accident a few days ago. Thing is she can’t remember it. She can’t remember if she ought to remember it. She plainly hasn’t had a significant head injury. She’s not had seizures in the past. We’ve no reason to think she has had one this time. Bur we’ve no convincing reason to think she hasn’t. She’d quite like to know, so we agree she needs a brain scan and a referral to a gerontologist for more clever tests. In the meantime I have to advise her not to drive anymore—not a problem right now, since her car has been written off, but still she needs to be advised.

16.20 Enter fourth patient (appointment 15.30). She needs to renew her annual repeat prescription for high blood pressure. So far her BP control has been o.k. Then this week she was told she might loose her job soon. And so might her husband. And her BP control has gone a bit wonky….

16.45 Enter fifth patient (appointment 15.40). “You’re running a bit late today—did you nod off for a bit?”

18.33 Enter DS Carter and WPC Watmough. Seems grabbing a punter by the neck and squeezing hard amounts to assault.

Hard to believe I know. Still at least Broadmoor might be a bit quieter.

Playing the percentages.

I’m perplexed. The game I’m in is all about communication, or so I’m continually told, and continue to tell the poor benighted Med Students that draw the short stray and have to make the trek out to Ambridge for final year community based medicine teaching.

Overall I flatter myself that that is one thing I’m not too bad at. If you want a fourteen point differential diagnosis for possible causes of a raised serum custard level you might do better with that nice Dr Neighbour—he’s got Medical Membership you know—but if you want your actual diagnosis explained then I reckon I’m yer man alright.

Now, this year, as every other this past four years, I and my confreres have been surveyed. In short for a couple of weeks around New Year and carefully worked out demographically accurate sample population from our surgeries were given questionnaires to rate us and our practice on.

We have just had the results, and sure enough my mean score for 10e (How well the Dr explained your problems or any treatment that you needed?) was a respectable 86%. I also got 83% for 10d (How well the Dr involved you in decisions about your care?).

Before we get too carried away the national mean for those two parameters, throughout the U.K. was 83% and 81% respectively, so not to be sniffed at at all. Still I must confess to being mystified, since despite these encouraging stat’s 11a lobs a dirty great spanner in the works. The self same population that gave those ratings, when asked in 11a (After seeing the Dr today do you feel able to understand you problem(s) or illness?) only muster a rating of 67% where the U.K. average is 69%.

So there you have it. Despite 3% better explanations than the average, and 1% more involvement my punters are ending up 2% less clear about their problem(s) or illness than their peers. Colour me 100% baffled.

On a brighter note Mrs Antrobus was in today. At 80 plus she had an umbilical hernia repair in the winter, and is now fully recovered. For the first time in almost a decade she has a flat tum, and can see her belly button. She’s so delighted she even asked her surgeon if she can get it pierced now—“Y’know, like that Brittney?”

Passsing through

Sorry to have been away so long. Not much to say, and no voice to say it in "blogger's laryngitis" if you will. There's plenty of stuff going on, but it's all pretty dull and uninspiring and I wouldn't want to inflict it on you good gentlefolk.

On the plus side we have sun and daffodils in Ambridge and at Jest Acres. On the minus we have a frenzied month of audits and compliance checks to finish the contract year so we can get paid. None of this is especially threatening, just mind numbingly tedious.

Somehow the regulars have also captured the zeitgeist and have been relentlessly dull and unimaginative in their presentations lately, so there's not much fun to be had there either. If anything amusing or interesting is actually happening here, it's not happening to me, so if you've got anything zany, philosophical, whimsical or perplexing to share, I'd be eternally grateful. If not I'll just go back to lurking, and spying on you all in the bloggosphere for a bit. just wanted to stop by and let you know I'm still around.

Just as an indicator of how low we've sunk, Hob Nobs are off, and I'm having to get by on Custard Creams.

Festina Lente

We could all learn a thing or two from the good burghers of Halberstadt. I learnt late last week from my good friends on Radio Four, that these fine folk have embarked on a monumental work set to far surpass and little local difficulties we might be experiencing in the developed world at the moment. In the midst of present financial and political turmoil they have begun a concert whose ambitions will, if completed, span generations, if not epochs.

As we all fret and worry about the fragility of the economy, witnessed locally by the flurry of job losses in the midlands car makers and their attendant parts suppliers, they gathered last week to witness the playing of a new chord in this concert. The chord began but and eyeblink (as I believe the literal translation of a German term would have it) ago in 2003. It will change every 18 months or so, playing steadily throughout the intervening span on the organ of St Burchard’s Curch. Played to its completion the piece should last around 640 years.

That’s right, YEARS.

The time chosen is significant as it reaches forward in time as far as the founding of St Burchard’s reaches back. In those intervening 640 years we have gone from illuminated manuscript to internet, and from horseback through horsepower to spaceflight. The way has been strewn with calamities, market crashes, wars and pestilences to be sure, but equally with triumphs in art, music, medicine and technology unimaginable to the Halberstadters of yesteryear.

I have a new thing to add to the list of “things to do before I die”, and this one should be there for generations of Jests yet unborn to do likewise, whatever befalls us inbetween. And for roughly twenty generations, should we all be lucky enough to be able to participate, and should the concert get to run its allotted course, we could all claim to have been present at the same event. A thought I find both humbling and ennobling. I doff my cap’o’bells to the fair city of Halberstadt and its visionary folk.

A mile in another man's shoes?

We moved to Ambridge late in 1990. Our first winter here was a proper Winter with a capital “W”. For four weeks we had a meter long icicle hanging off the corner of the conservatory at Jest Towers, and our poor late lamented moggy (then a spry young two year old) could wade chest deep in snow like a little ginger Bismark.

One especially icy Saturday saw Dr Neighbour and I abandon our attempt to drive home from the duty surgery at the foot of Lakey Hill, after some pillock had jack-knifed his artic’ across the road. Instead we stumped up the hill and back to Jest Towers afoot, like Pooh and Piglet tracking woozles—only stopping at the top of the hill for a reviving medicinal port in the now demolished Lakey Arms. When we made it home we ended up calling Radio Ambridge, to warn the punters there was little point calling on the duty doc that weekend as his car lay abandoned and almost all roads were impassable anyhow. Later that afternoon (once the “medicine” had worn off a bit) we went back with spades and dug Dr Neighbour’s car out, and let our newfound Radio chums know we had restored normal service. Since then Ambridge winters have been a bit of a damp squib—though often very damp indeed to be sure.

Until now.

This week we have fallen pray to a new meteorological phenomenon, the “Snow Event”. Indeed, we have had two such thus far, and can apparently look forward to another on Sunday. On the minus side it’s made all the roads hereabouts really slippy so driving has been a bit of a pain. On the plus side it has made all the roads hereabouts really slippy, so the schools have been closed and nobody has been mad enough to venture out to work, which has made driving an absolute joy, especially when, as this morning, you get to drive through countryside where every tree and bush stands limned in glittering white frosting, in the special silence that attends fresh fallen snow.

Better yet, when you get in to the office, scarcely later than on a normal day despite the “extreme” weather, everyone is so pleased to see you, and many of the regulars, having take a peep out from under the duvet, have decided they can wait a few more days before coming in and so have cancelled their appointments, making the caseload a little lighter. Intriguingly though one group of patients seems to stick at nothing to come in, those with pre-existing mobility problems. One poor old chap even managed the two mile walk in for a routine review of his Parkinson’s Disease since the busses weren’t running. It’s almost as though the snow doesn’t impinge, or that it is just another and perhaps more trivial challenge to their mobility.

I'm pretty sure they could teach the rest of us a thing or two.

Bust....

… and Boom.

Or so it would appear. It’s been a nervous six months for the denizens of Ambridge. Light industry hereabouts had evolved to serve the needs of the midlands car makers through the boom years of British manufacturing industry. Those few that are left are all teetering on the brink of the much bruited recession, resulting in increasing uncertainty, lay offs, redundancies, short time working, and downwardly spiralling incomes for the majority of folk.

Add to that rising fuel costs and the coldest winter on record (well o.k. not quite perhaps, but certainly one of the chilliest I can recall) and it all adds up to a pretty miserable picture. Or so I thought until yesterday morning.

You see, we Yeomen of Borsetshire are a sturdy breed. When the chips are down we rally round and make the best of things, and when, as this year, there’s no cash, no heat and nothing worth watching on the telly, we can make our own entertainment. And it seems we have been. Rather enthusiastically.

And the upshot of all this “entertainment” was made manifest not once, nor twice, but three times in the space of one surgery yesterday morning. On each occasion in strode a confident looking woman (one with sheepish partner in tow) with a particular half-smiling expression. These days I hardly need to ask, but do so, just to observe the formalities, thus;

“Now what can we do for you Ms….?”

And they reply “I’m” (or once “We’re”) “pregnant!”

There follows a round of congratulations, followed by one (well, yesterday three) of the most joyful consultations you can get in this line of work. With the obvious exception, I’m not sure there’s a better way of spending a morning ;-)

On being pleasant.**

It’s been an odd week again. The ongoing Ambridge Lurghi hasn’t helped, to be sure, but there’s more random weirdness abroad at the moment to go along with it. A case in point is young Elwood, a precocious little four year old who can already spell “Triceratops” and who has a friend who follows him everywhere, name of Harvey*. Elwood’s ears have been feeling a bit sore lately, so Granny brought the two of them in today.

“Harvey’s been poorly” chirrups the lad as Harvey takes his accustomed place seated beside his bestest friend. Elwood’s feet dangle over the edge of the chair, but as I round the desk I am careful not to step on the altogether larger paws of poor old Harvey.

I mime lifting aside a long lop-ear and gaze into space through my auroscope, a good two feet above the upturned face of young Elwood.

“It’s o.k.” say I “Harvey’s looking fine today, now how about you?” and then little Elwood proffers his own ear for inspection.

“Hmm. Not quite as good as yours I’m afraid,” I address the remark to the spot Harvey’s face should occupy. “I think the lad needs and antibiotic, just to be on the safe side.” We all three nod (Elwood assures me so), and off the two friends go, hand in paw, Granny in tow, clutching a script for Elwood, and the invisible carrot I proffer for Harvey’s trouble. I have a special jar of them on the desk, just for Harvey’s visits. Fortunately, being invisible it doesn’t take up much space.

* names changed to protect the innocent. The Triceratops, however is real.

** E-V-H-Ns (TM) on offer for the derivation as usual.

Learning to take the smooth with the rough.

Such is the perversity of human nature that I am starting to fret a little. I’ve become accustomed to a more or less steady diet of woe and misery over the last couple on months. The problem has been another winter of intractable cough bugs, with flu like illness chasers, that seem to have been doing the rounds in Ambridge for ever—or at least since early November.

There’s no denying they have been pretty miserable for the poor blighters who have been afflicted. Problem is they’ve also been pretty un-amenable to medical remedy. This has two effects. First it fills surgeries with a lot of miserable people, all lining up to be told, in so many words, there’s nothing we can do for them. Second, and almost more pernicious, it leaves one with a gnawing feeling of clinical impotence which, left unchecked, can lead to an appearance of uncaring dismissal when presented with yet another poor bastard with the lurghi.

The end result of such a downward spiral is a whole bunch of miserable patients and their miserable medical attendants, all moaning to and about one another. So if there’s anybody out there with a miracle flu remedy they can share there just might be a hob nob or two in it for them from this oppressed and downtrodden GP at least.

And then, today, for no clear reason that I can fathom, all the punters have been being especially nice. You know the sort of thing…

“You’re looking well today Dr J, have you lost weight?”

“I swear you’re looking younger now than the last time I saw you!” (Which was five years ago by the way).

“Thank you for your time. I feel so much better just for talking…”

So why do I sit here waiting for the next bombshell I wonder?









As an aside I heard on dear old Radio 4 at the weekend that the good burghers of Brisbane are teaching relaxation technique to toddlers. I feel vindicated. Someone in Oz has obviously been listening to my inane ramblings. Just remember, you heard it here first. Dr J the visionary!

Did you just hear something then?

So that’s it then. New Year rung in in suitable style at Jest Acres after trip to the Panto, New Years Eve banquet in the great hall to follow, concluding with the now traditional sybaritic orgy that is the chocolate fountain, and Jools on the telly in the other room Hootenannying for all he was worth. All in all it went rather well, though the return to a duty surgery on Friday the 2nd was a suitably sobering return to earth.

Still the New Year is off to a suitably surreal start, that if nothing else shows the perils of “copy and paste” correspondence. For a long time there have been parallel moans in U.K. health services. The hospitals moan that GP letters are often a bit sketchy, frequently penned in haste at the bedside as they are, and so are inclined to leave out essential titbits, such as the patients inside leg measurement and so forth. In turn GPs have moaned that the discharge letters thrust into the hand of homecoming patients tend to lack vital, or at least legible, information on trivia like diagnosis, treatment and follow up arrangements. This has, to my knowledge been a settled and steady state for at least three decades. I suspect even poor old Hippocrates had young whipper snappers moaning about the appalling state of the handwriting in his wax tablets down at the Kos DGH.

But over the past three or four years we have moved to printing a lot of the more relevant patient data onto an encounter sheet to attach to our urgent referral letters, and the hospitals have moved to IT generated discharge summaries which are way better than the pro-formas of yesteryear. The problem comes when these IT generated documents are pre-formatted for routine entries of common data, and not edited for those that do not apply, as happened today. Or at least I very much hope that that was the case. Otherwise we have a patient who died in hospital, but was found to have a normal temperature, blood pressure and respiratory rate on discharge from the ward to the mortuary…..

Must go now, it’s dark and there’s a strange tapping sound at the window.


Errr Hello!

Is there anybody there………….?

Twelve years and counting...

There’s no doubt that as we enter the 25th year of my professional life we’ve come a long way in the intervening quarticentenary*. Two generations of pills have near abolished surgery for stomach ulcers, a tiny bit of wire mesh has gone a long way towards doing the same for bypass grafting. Depression has been transformed by the introduction of SSRIs and the plethora of follow on alternatives. New wonder drugs have been joined by rehabilitated old wonder drugs like Aspirin. Endoscopic surgery and joint replacements are now commonplace and the protracted stays in hospital post op are a thing of the past for the vast majority. Cancers incurable a generation ago are so no longer…. I could go on, and on (stop that nodding there you at the back).

And yet, for all our technological and pharmaceutical accomplishments, as 2008 draws to a close I’m left fearful that we’ve "sold our soul", and ere long Old Nick himself will be paying us a visit to call in his marker. The NHS I joined, for all its evident faults, was a truly National Service. The ethos of the whole organisation was compassionate, aimed at the relief of suffering and the improvement of wellbeing. This morning on Radio 4 we hear of a Kings Fund report highlighting the loss of compassion. This has slowly but surely been eroded by the fragmentation of the service into a vast jigsaw of Trusts each as much determined to protect its borders and boundaries and keep the “undeserving” out, as to hit the targets set for service delivery to those fortunate few “deserving” of its attention. And those targets are all about process. Waiting times , cleaning regimes, infection rates and the like. All of the above are important, but so are the poor bastards stuck on the receiving end.

In the past month I’ve seen patients kicked off waiting lists for surgery because on one screening visit to a N’octor, their blood pressure or blood sugar are not exactly normal according to arbitrary criteria that are almost absurd enough to require that to be fit for surgery you have to be so well as to not require surgery. I’ve heard Doctor Neighbour bemoan the fact that he is unable to arrange a transfer ambulance to get a patient to see a Neurosurgeon at St Elsewhere’s in a nearby city because the Surgeon in question wanted to review them in the A&E department there and the Ambulance trust can only take patients to Outpatients there or to the nearest (Ambridge DGH) A&E but not the St Elsewhere’s A&E because those are the rules. And I’ve seen a patient denied much needed Opiate analgesia because staff at the residential home he lives in cannot find a cupboard to lock his medications in and the rules won’t allow them to do otherwise.

We’ve become afraid to care, and it’s getting steadily worse year on year. Maybe the Kings Fund will turn the tide and 2009 will see a return to the much needed basics. Every Trust in the land has a mission statement that declares in Government approved newspeak their commitment to “patient centred-ness”.

It’s time we all sat down and thought about what that actually means.

*probably not a real word, but should be.

Tis the season.

Sadly not much jollity in evidence in these parts though. One tiny ray of personal sunshine is that Whittards has found a buyer so I sha'nt have t worry quite yet about where ny next 250g of fresh ground Old Brown Java is coming from. I know there's always Taylor's of Harrogate, but it's so much nicer seeing an operative pour the beans out of the tin and into the grinder, whilst solicitously advising that once ground it's only good for a week or two at best, and asking whether the filter I'll be using is paper or permanent (aparently it makes a big difference).

Even the early a.m. run to collect the Turkey from M&S was a muted affair this year. Normally the place is heaving with beaming and avuncular types cheerily queuing for their produce and knocking back simmering goblets of mulled wine. This morning there were a half dozen bedraggled pensioners, a harrased looking suited lady exec and moi. And not a whif of mulled anything. Looking back on 08 it will not go down in the annals of Ambridge as an especially kind year-- and this was before the "crunch". Looking forward 09 doesn't hold out the prospect of being much better.

Still so long as there are Hob Nobs and Java to be had life can't be all bad. And I am as always eternally indebted to those of you who are kind enough to feed back on my ramblings. Your generosity of spirit, and lack of sound judgement, do you all credit, and I wish you all as safe and happy a Christmas and New Year as is humanly possible.

I may well be back before the latter (it's business as usual here Monday through Wednesday) but if not then I hope you will excuse me.

Now I'm just off to google McVities to make sure they are not yet in peril of calling in the recievers, so if you'll all excuse me.....