Saturday, 31 October 2009

Halloween some Odds and Sods

A few little bits have caught our collective eyes as we here at ND Central go through the 100+ letters we each get a week.

We are always keen to “embrace” new treatment options and the suggestion by one of our local eye consultants for us to arrange “dermatological relief” for a patient was interesting.

It reminded one of us a line from a UK gangster film, we think it was The Squeeze 1977, where a cop was asked if they wanted “special relief”?

Another new therapy we observed for treatment of a fracture from an orthopaedic clinic was to try “vibration massage therapy”.

Long gone are the simple days of plaster of Paris, metalwork and the odd antibiotic as core orthopaedic treatments.

As none of us knew what these actually meant we felt we have either been out of hospital medicine too long, watch the wrong kind of films or have an odd sense of humour?

We could also just be plain pig ignorant. Still it gave us a few giggles.

The Walk In Centres continue to provide us with lots of evidence of rain forest deforestation but not much evidence of useful work.

One punter, sorry patient, there is of course no real market in the NHS, had been 5 times in 4 weeks and the history and treatment was the same on all 10 sheets of A4 paper produced.

The same history, examination and conclusion = “viral infection”, all 4 lines of it, in the 2 sheets of A4 per attendance repeated 5 times was as relevant to us as GPs as a used piece of toilet paper in a sewer.

Unfortunately one question had been consistently missed and had it been asked, 2 weeks ago, would have given the diagnosis in 2 minutes not the 5 times 20 minute consultations.

We asked the relevant question and the patient got better with the right treatment.

Someone has said that 85% of diagnoses in General Practice you can get on the history alone.

All of our consultants at medical school said that a good history was vital and only after a few decades of multiple history taking and seeing lots of patients and doing sometimes many unnecessary tests do you realise that this is true as a result of experience not a short course.

Until you observe those in training (medical students, F2 trainees, registrars and even nurse practitioners the new Vim of medical healthcare on the cheap) and how they fail to listen though inexperience, not inability, you do not realise that taking a good history from a patient is an art that takes a long time to do well.

That is if you can remember your own short comings, which we feel is vital in teaching, for if you forget how bad you were once, you become intolerant of ignorance which we should be correcting via education not humiliation.

These skills cannot be learnt in a few short weeks or, even less now, as “education” has improved so much under ZaNu Labour’s rule, that in 3 hours of Party sponsored “how to (mis)diagnose swine flu” courses anyone can play doctor and get away with murder.

We are situated close to several largish conurbations and we have noticed a number of different formats of walk in consultation printouts (mostly rain forest and knowledge unfriendly) but one we had not seen until now had the following code sitting in amongst the crap printed on them:

Mobility: WALKING

We shall be looking out for any variations on this one given that these are “Walk In” centres.

Would one get treated if you “hopped in”, “roller bladed in” or were “carried in”? Would that alter the mobility code?

Surely given their name, all mobility codes should be “Walking”?

Heaven forbid someone from a local military base might abseil in from a helicopter but we are sure there must be a code for that, comrades? Or would they be denied treatment as they did not walk in?

Finally we asked each other how many cases of genuine swine flu we have seen?

Answer none. Lots of Tamiflu positive patients but no genuine confirmed cases. There are rumours that the Health Protection Agency have been swabbing patients and finding large number of people have had swine flu but with little or no symptoms. These are just rumours which will no doubt be suppressed as if this got out there would be nothing left to panic the population with and the benevolent vaccination program might not be of any use.

Still our patients know better than as all of them are convinced they have “flu” but they have managed to drive in, park their cars after taking their kids to school, on their way into work and then walk in to see us to tell us they have “flu”.

These acts themselves tell us they do not have real “flu” most of them just have minor upper respiratory infections as do the rest of their families, schools and work places which is usual at this time of the year. We are still waiting for our first proven real bacon butty case of flu.

It is of course Halloween so no doubt the Department of Health will be allowed out to play out unchecked for one night of the year in contrast to the rest of the year when it inflicts all manner of horrors on patients via their “initiatives”. This morning’s patients at one of their bright ideas, the Gordon surgery for busy commuting pensioners, at one of our less affluent branch surgeries more than surpassed the local supermarket’s Halloween horrors and that was in daylight.

Praise be to the Party and all its new health reforms.

We wonder which one of them was responsible for the new “reliefs” and “therapies”? Sir Liam or possibly Dame Christine or maybe it was a joint effort?

No doubt NICE approved all of them as part of evidence based politico-economic medicine if only we could recover their rainforest depleting missives from our shredder to read the relevant ones . . .

Has science finally disappeared from good medical practice or are we just taking the proverbial?

You decide dear reader we just live this daily. Beware the ghouls and beasties tonight for if they do not get you the DoH will!

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