Thursday, 11 November 2010

Memory.



One of the great things about a health service where nobody pays the doctor directly is the effect it has on our patients. We had a discussion at our weekly resistance meeting at the CafĂ© Michelle about our collective experiences at one of our more “exclusive” rural branch surgeries.

At this surgery you are immediately out numbered in the car park by the scores of Range and Land Rovers driven by our patients as well as their employees’ tractors and various instruments of agricultural production.

Given that the Ferraris driven by all UK GPs and their staff, are low riding beasts compared with those above us, this is a truly hazardous place to be in. One misplaced dung dispenser dispensing could seriously damage the shine on the average UK GP’s Ferrari.

Still that was just the car park. Worse is yet to come when we deal with the owners of these vehicles our patients whom we allegedly serve. For some unknown reason when a patient sees their doctor in the UK, the National Health Service manages, at no cost to the patient or the State, to perform a partial cerebral lobotomy the minute they walk into their GPs’ consulting room.

Our patients are in effect rendered brain dead but unfortunately still breathing, walking and worse still talking. After their NHS “free at the point of care” partial lobotomy the response to open questions such as “what is the problem?” or “how can we help you today?” is:

I don’t know? You’re the doctor, you tell me!

Oh so original, you can tell a farmer a mile off. They’ll talk to their vet ad nauseam about a speechless animal whom they pay for but come to a doctor, whom they do not pay for, and they will expect a full tank of diesel and a diagnosis before they go off to spend their EU subsidies.

A quick “if you want to play stupid see your vet (they charge)” usually results in the realization that it is not the doctor who has the problem but the patient and the doctor needs something called a history in order to do their job.

In other words talk to us (you dumb animal).

The NHS “free at the point of care” lobotomized patient then usually goes onto refer to their problem as “it”. Even when questioned about every standard symptom of disease for example is “it” chest pain, or shortness of breath and so on the problem is still “it”. What “it” is we sometimes never know especially in the demented when they attend sans relative, an increasing phenomenon.

We are not veterinary surgeons for in the UK they are usually much brighter than we doctors. Their patients do not talk but their owners do in order to get value for their money. However, when patients present to their GPs without their pets which cost, they are allowed to be dumber than your average vets’ patients (the animals that is).

At this stage in the UK, a GP presented with their lobotomised patient inability to communicate may then have to examine their patient. This always presents further problems. Simple instructions like lie on the couch on your back can result in the lobotomised patient assuming a knees elbow position on the desk or lying sidewise facing you in the room next door for reasons beyond our comprehension.

Even if you can get your patient into the correct position you are then faced with the fact that the patient cannot remember what clothes they put on in which order and so 5 minutes can be spent trying to get to an upper arm released, with help from a relative/carer/friend, from the unique combination of bra, bodice, corset, suspender belt, vest, incontinence pad(s), catheters and thermal long Johns. Did we forget the body warmer and hat too and to remove your glasses as well when the ankle is being examined?

And that is just in those patients called John. Jane Does are worse. Which bits of the English language they missed at school we know not but our medical students frequently comment on how thick our lobotomised patients are. For even as medical students they know the difference between up and down, left and right, arm and leg. Remarkable.

Following the “history” and “examination” part, one may then have to prescribe a treatment.

This is fraught with hazards as such questions as “Do you have any allergies to any medications?” will result in answers such as “Yes it is something with an A in it. Or is it a C?” or “Are you on any other medication?” are usually met with responses such as:

Yes I am. You will know what I am taking.”

You are asked to prescribe a drug, a poison, which they take regularly but don’t know what it is? The hospital, or you, “just” gave it to them and “it will (always) be in the letter” you have not yet got as they only saw the consultant yesterday.

Notice the “it” word again?

If this isn’t the case they will have of course taken all the tablets and disposed of all boxes, any discharge letters or prescriptions but the patients and their relatives will always say:

You will know what it is it will be ON YOUR RECORDS."

Whatever a patient does not know it is always ON YOUR RECORDS.

You will know my case. I am a new patient it will be ON YOUR RECORDS”.

I have seen a doctor at the hospital and rang the labs and they tell me the results are there. Can you get them for me? It will be ON YOUR RECORDS the hospital said so”.

Top tip if a doctor in hospitals says a letter will be with your GP in less than 2 weeks ignore it.

2 weeks is a BARE minimum so don’t waste an appointment try, if you can bringing the drug boxes, or the discharge letter for the helpful phrase heard so often in General Practice of “They are THE little white tablets” is about as helpful to a GP as “it was a blue car with wheels on” is to a Police officer.

Which doctor, which hospital, which department? Which car?

"I don’t know? It will be ON YOUR RECORDS."

In reception you will hear the following “I would like my tablets”.

Which one? (of the twenty you take)”

"I don’t know it will be ON YOUR RECORDS." Now this is the NHS, which is free, but try asking the same lobotomised patients what car they drive?

They will have already clocked your car, told you how Top Gear have rated it and how their relatives have something so much better than your NHS Ferrari. They can complain about how much petrol costs per litre to the nearest tenth of a penny when its MOT is due and how much a full service costs. You will get the full spec and any problems they have ever had with their vehicle without you ever hearing them say “I don’t know it is ON YOUR RECORDS”.

The amazing thing about the NHS “free at the point of care” partial lobotomy is that once the patient leaves the surgery they suffer from instant recall about the whole of the consultation and leave with super uber enhanced memory powers. You then hear them saying in the supermarket:

“My doctor could not tell me what was wrong with me and I told them everything . . .”

“My doctor did not even know what tablets I was on . . .”

“The doctor didn't have a clue I don’t know what they are paid for. . .”

This is especially so when they sniff the quick buck of litigation and enhanced memory goes into overdrive. People who could not remember the 1 times table at school can suddenly quote pi to a billion digits to a lawyer.

We have been trying to find the origin of a quote we once heard that we thinks may explains this (almost) universal amnesia of the UK population when it goes to the GP and we think it goes something like this:

That which you do not pay for, you value not.

That which you value not, you respect not.

That which you respect not, you despise.

That which you despise, you abuse.

Anyone working in healthcare disagree? We bet none of you have had patients like ours?

Praise be to the Party for free healthcare and education. One of them works despite the other failing completely. Problem is we at ND Central can’t remember which is which.

Curious that? Must have breathed something in, it must be very infectious . . .

PS Anyone who can help us with the original quote above we would be grateful. Over a century of collective medical experience gets a bit forgetful . . . you will know what it is doctor it will be ON YOUR RECORDS!

2 comments:

HyperCRYPTICal said...

Sir!

I am outraged by the content of your poisonous post, in that it pertains to the most precious part of your practice, that is, your patients.

We are your bread and butter sir! I am aware that you receive large payments per practice patient on an annual basis, and the proof of the pudding is there to see in your carparks - your GP Ferraris blocking access to my husbands combine harvester. Sir! You have the nerve to gloat about it!

I find it appalling that you expect your lobotomised patients to provide you with clues as to their presenting complaint! I can only presume that your diagnostic skills are pretty shabby! A bad workman always blames his tools!

I must state that neither my husband or my good self have received our free partial cerebral lobotomy! Why is this? Why were we not informed!

That aside, I must inform that I am a seldom attender to my GP practice - only attending three times per month. I find the assertion proclaimed by most GPs that they are rushed of their feet by timewasters laughable - for it is a fact that my own GP is so damned lazy, he cannot be bothered to check my name before I enter his office. On several occasions he has addressed me as Mrs. Heartsink, when it is ON YOUR RECORDS that I am Mrs Jones!

I believe your post has caused much harm to patient well-being and trust in GPs will be at an all time low; I am indeed, quite traumatised by same and shall consult my doctor today, as I feel I need some of those little white pills to calm my nerves!

The quote! Despite spending several hours attempting to check its origin (this time could have been spent better in checking the prognosis of my particular complaints), the nearest thing to it is: "What we obtain too cheap, we esteem too lightly; it is dearnesss only that gives everything its value" Thomas Paine.

This of course will not be what you were looking for, but I did try!

Anna :o]

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