Soap...

...opera.

I understand that when the scripts are delivered for Eastenders the whole cast scrabbles through for the last few lines to see whose turn it will be to get the"Doof Doofers". In other words who will get the cliffhanger line bofore the terrible '80's style synthed drumbeat that heralds the closing titles.

Every now and again you get a consultation that has the same quality. Yesterday I had two in rapid succession. To keep the theme lets call them Phil and Grant.

Phils tummy had been feeling "wibbly" for a few weeks. Not painful and not really sick, but something in between the two. You know. Wibbly. We went through the usual questions and no he had been neither sick, nor had loose stools or constipation. The family had sent him because he had been abroad some while ago and might have "picked something up". His tummy was soft and non tender and gurgled just as it should down the stethoscope.

Cue the trademark Dr J quizzical look *?*.

(A very handy device for hinting without actually coming out and saying to a paying punter "I have no clue what's the matter".)

Then he let the cat out to play with the pigeons when he said "Would stress have anything to do with it?"

Within ten minutes a tale of loss, bereavement, and reaction to same, emerged and the wibble made rather more sense. We agreed - after a more detailed assessment of his mental state - that he was not depressed, though still having some sad days, and that anxiety was the likely cause of his symptoms. I did offer medication but on the whole he looked so much better for having had the chance to talk through and explore his feelings that he may well not need any.

Grant was another matter. He came in after a "note for work". Or put another way, a sick note to certify him as unfit for work.

*?*

He was "upset" after leaving his wife only to find that his boyfriend then left him.... there was a lot of other stuff besides but already the mental synth drums had begun "doof doofing". This being real life and not just soap opera, of course there were no closing titles, but after a simlar assessment we were able to decide that Grant, unlike Phil, has been made depressed by his stressors and so he went away with a note, a script and an appoitment for review in two weeks. In other words, to be continued.....

So maybe life is more like a soap than I like to pretend.

Becalmed

Bank Holiday weeks are always a bit funny in Primary Care Land. Tuesday becomes Monday only slightly worse ('cos we were shut for three days over the weekend instead of just two) and this Tuesday moreso (four instead of three...). The result, a duty surgery from hell, essentially double booked all through the afternoon, and a gazillion visits in the visit book beforehand.

Ending with a very harrased and tired looking Dr J home late Tuesday evening. Still nothing a stiff Jack Daniels couldn't cure.

Wednesday and Thursday were much the same, though the intensity came down a notch or two.

Which brings us to Friday. Yep. You guessed it, Dr J in the Duty surgery again. And it's like a ghost town. Just one visit after morning surgery, barely half the appointments taken, and, mystery of mysteries, three no shows.

I still have difficulty with this concept. To get a Duty appointment you have to book it on the day, so what can make you ill enough to need the Doc before mid-day, and yet be better before 3pm? Then the paranoia starts to get to you. What if they got to find out it was Dr J on duty today and decided to vote with their feet. Maybe not everybody loves me...

Maybe it's the new improved "Gregory House" style bedside manner. Or perhaps it's just that it stopped chucking it down and looks like a nice weekend?

Still the desk is a lot tidier and the BMJ backlog has shrunk a bit so it can't be all bad.

250k

I've decided I like the controller of Radio 4 after all. Thanks to him (?) it appears I have just been given a truly astonishing pay rise. Of course, like a lottery winner I now expect to be deluged with begging letters and dodgy "investment opportunities", but then, if I'm pulling down a cool quater mil a year that's just par for the course. So, when can I expect my cheque then eh?

Sadly Borsetshire GPs aren't quite so well favoured in fact, so don't go getting your hopes up just yet folks. It seems I shall still be having to turn up to see the punters and troll out this drivel for a while longer, rather than have my butler do it.

Some, likely very few, of my colleagues may be able to command such sums, but not in our practice, where much of the "extra" cash netted under the new contract goes to pay for the running of the surgery.

Don't get me wrong, I wouldn't have it otherwise, and I'm not moaning about my earnings, though they don't even come close to the mythic 250k. I just wish Aunty Beeb would look into their stats a little closer before bruiting about that I and my colleagues are the grasping nemesis of the poor NHS for making our contract work. It also irks that they are trying to blame the appalling deficits now emerging on the consultant contract and nurse pay awards.

Still I can't sit here burbling all day, I've got a duty surgery to do.

And a Bentley to order, what!

He must be ill....

So says the close relative of a patient hospitalised after an overdose. It's the third this year, and they are getting more serious at each attempt. The family have tried pulling out all the stops when they get the call, followed by a more standoffish response, followed by "Tough Love". None of it makes a difference.

Booze is a big part of the problem... that and a hefty dose of denial. The loop of admission, dry out, Psychiatric evaluation and discharge revolves around and around. The problem is "Deathwish" is not a condition covered by the Mental Health Act.

You might argue that repeated efforts at self destruction suggest a soul in torment and in need of help. Indeed it's hard to contend otherwise. But if, on "recovery" the patient can say "I'm fine and I don't need your help" and keep a straight face while doing so, the Psychiatrists hands are tied. Serial "offenders" become well known to their local A&E and Psychiatry teams, and are treated with diminishing regard and respect at each attempt, and many eventually get it spectacularly wrong, and the cry for help ends up literally costing them the earth.

After a forty minute call in which the best I can offer are platitudes and contact details for a support group for families, I am left with the feeling, again, that there ought to be more that we can do.

Then step up Radio 4 (yes I still think they are listening in to my consultations) and the delightfully named Prof Nut a Bristol Psycho-pharmacologist, who says that we may be no more than five years away from antidotes to the "harmful" effects of alcohol.

I pray that he is right, and that this family can wait that long.

Spring is Sprung

At the risk of sounding obsessional, What-On-Earth-Is-Going-On?!

I know I've just been away for a week so appointments have been hard to come by and all that, but SIX antenatal bookings in two days! This is getting beyond a joke. And they'll all be queuing for trolleys in the delivery room in November / December if my surgeries are in any way representative. (And you might have guessed I don't do home deliveries).

So what was it about February this year that has resulted in this little baby boom? Could we be witnessing the results of a cold and dismal winter combined with a Gas Price hike of monumental proportions here. It's starting to feel like the good/bad old days of the three day week and the nightly power cuts with their resulting "baby boom". I know the TV schedules haven't been up to much lately, but do people really have nothing better to do with their time nowadays?

What's the matter with a nice game of Scrabble, a cup of Horlicks or a long bracing walk in the fresh air then eh?

Of course it's nothing to do with the fact that we haven't had a Family Planning Nurse since our last one left on maternity leave now is it?

Right now that's out of my system perhaps we can go back to the wry observations about health, illness and the like instead of all this talk about babies and child-birth and such.....

So why are you Doctors....

... so against home deliveries then?

So said our MP a month or two back, to a room of GPs convened to discuss, inter alia, the threatened closure of our local DGH. The question came on the back of plans to move maternity services out to Borchester (some 20 miles away) which in the Hebrides I grant might appear a trifling matter, but not so here.

It was clear she was a fully signed up follower of the New Labour (no pun intended) "choice" agenda, and was firmly of the view that women should have the "right" to deliver wherever and however the fancy took them.

It was also clear she was the only person there who has not been in a room with a mother and a newborn, dead, infant.

Now such events happen in or out of hospital granted. But at least in hospital, we all felt, there are the kit and the facilities to try to prevent such an outcome in a way that is just not possible at home. Also for most of us the only deliveries we had attended in the past decade had been those of our own offspring-- all hospital delivered, and not by us.

It is perhaps regrettable that as GPs we are becoming ever more remote from one key aspect of family doctoring, but on balance many of us feel we lack the up to date skills and adequate backup to offer such a service. However, it remains the case that in Borsetshire 10 out of 10 GPs would recommend Hospital Delivery.

The Doctor is Out

It's the Easter Hol's and the kids need some quality time with Daddy.... oh, and childcare arrangements proving a little fraught this year, so I am out of the office for a week, doing chores. See, quality time.

Still our staircase now looks all shiny and new. After three years of the minx sliding down the bannister and swinging on the newel post the wood was showing through in a few places. I now sit here paint spattered and with hair prematurely white-- lovely and glossy though-- watching the rays of the morning sun glare dazzlingly from the aforesaid woodwork. I'm also a little giddy from the smell of the paint if truth be told, but it's still a bit cold here to throw all the windows open. The minx moans when her teeth start to chatter, and I'm already in trub' for forgetting to close the bathrrom window early enough last night so she wouldn't freeze when she went up -- "mind the paint!"-- to get ready for bed last night.

Tomorrow we head for the wild west-country, and the computer is not invited, so "normal" service will be resumed next week.

Of course meawhile, having done the stairs, the skirting in the hall is looking a bit shabby. Or minx and I could spend some quality father/daughter time while we wait for big brother to come back from "camp", and mummy to get back from the office.

Must dash, I think I can hear the sound of a ten year old stuck to a bannister!