Archive for May, 2007

Detective Max…

Posted on May 31, 2007. Filed under: Journal from behind the desk... |

A word of advice, don’t try lying to your heath care professional….

Two reasons -

Firstly: We actually want to help you. So why tell us porky-pies.

Secondly: You’re not the first person to pull a fast one nor will you be the last.  We are masters in communication skills, and we know B.S.  when we hear it.

We are good detectives, it’s our job.  We have diagnosed your torticolis, depression and alcohol problem before you’ve got in the room.  We saw your limp, noticed the blood, identified the rash before you sat down.  Private investigators have nothing on us…

The reason I mention this is-

“It was a sunny day when he walked into my office, I could tell by the way he coughed his chest was in a bad way. I asked if he smoked, he said no.

I know this is not true… does he have tell tail signs?

Stained fingers, nicotine malodour, skin that looks older than the person wearing it….No, actually he does not.

So how did I know???

….Pack o’ cigs in his top pocket!!

“Oh, those…Well yeah, I ‘ave one or two, any’ow I’m quittin’ soon”.

So I go on to tell him about our range of services available to aid him stopping.

“I ain’t having any of those Nico’een patches, they nearly killed a friend of mines ‘usband” – the patient is unsure how, but insists they “nearly killed ‘im”

Did the friends husband try to smoke them I wonder, or did his wife put the sticky patch over his mouth to stop him smoking and also obstruct his airway? That’d nearly kill him.

The morale of the story is don’t tell us fib’s…(We are the latest in the CSI franchise – Clinical Scene Investigation)C.S.I. Crime Scene Investigation - The Complete Sixth Season

Enough from me…..

Kim’s been at it again with – cos So off you pop…. come back soon…

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£10,000 for a free paper!

Posted on May 24, 2007. Filed under: Journal from behind the desk... |

I escaped my desk for a few days to return to my home town. 

 st_margarets_ave.jpg

Crappy little place, doesn’t change much. So why did I go? -Well my grandparents are still there, and my grandad was going in for a TKR, my Grandma is a bit of a worrier.

So being the kindly grandson I am, I took them to the hospital on the day of the op., then stayed with Grandma over night to distract her from whittling and took her in to see her hubby the next day.  All went well. So why do I tell you this???

Well…it was a bit of an insight into the world of non-NHS hospitals.  My grandparents stopped paying for their private health insurance when they were 60, as the premium went up significantly, so 20 years later the old boy wants a new knee, so they pay just under £10k for one new knee (or is that “won knew nee”) and a week in hospital.  (They worked out it would have cost more if they’d kept paying the insurance!)

My grandma kept going on about how fantastic it was, and were immediately impressed when they were asked if they wanted a “complimentary” newspaper.  As I pointed out to her for £10k, it is not really free…

DAYLIGHT ROBBERY

…and then it all started… NHS bashing care of my elderly relatives, with not a single thought that for a great many years I had been employed by this tiny little company they were having a go at…

“Well, you wouldn’t get a complimentary paper in the general hospital”  I was a good grandson a nodded –  rather than saying…

“No, that’s right, but at least the doctors don’t all go home at 6pm, so they have to call an ambulance if anything goes wrong and get you shipped to the local NHS hospital”.

OK – so perhaps the private health cares “free” paper  verses the NHS 24/7  medical staff and emergency service availability is an unfair argument.  

It was a very tidy, quiet and neat little hospital, and the staff were lovely and in abundance (4 physio’s in a ~20 bedded ward!), my grandad could sleep in his own quiet side room, rather than in a busy ward. 

 So perhaps you get what you pay for…(depending on your taste)

 

BUT THEN….Grandma really rattled my cage with the: “the staff are lovely, they must hand pick them!”

Oh yes…..

…..of course because in the NHS they just drag people off the street, I’ve never been interviewed!  Beverly Allitt was interviewed and picked.  Need I say more.

Well yes actually…. If I was grossly overstaffed when I worked in hospital I would be lovely to my patients, rather than just doing my best to keep their treatment moving along and ship them out as smoothly as possible, whilst trying to do 20 other things.

Now I know that my Grandma just wants to know she’s getting her moneys worth and that her old Herbert is in good hands, but watch what you say.  She stopped being so NHS derogatory after I pointed out that most of the staff probably work for the NHS in their spare time or have done at some point in their careers, so she was likely to offend.

So…..my conclusions:

Private health care for routine op’s seems fine by me. I have no worries ethically about it. Just don’t knock the NHS! I don’t work for the NHS anymore, but I am still protective and proud of the good service they provide – and given the choice between a paying for a newspaper or paying for a knee replacement – I leave that to your discretion…

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It’s not unusual…

Posted on May 18, 2007. Filed under: Journal from behind the desk... |

At no point did I suggest that I am intelligent!

Not good at mathematics?

Reading around these pages you will quickly realise that I have done and said stoopid things…

…but sometimes I excel at it…

Every day I examine multiple chests, but today I found something unusual – there was a wheeze in the patients R upper lobe – it’s not unusual…

It happens all the time.

But then….it disappeared!

It reappeared on his L lower lobe – and then was gone again.

It reappeared on his R mid lobe – and then was gone again.

This is odd.  Eventually after a fair bit of double checking, I came to my diagnosis….

His chest had globally clear air entry but….

My nose was whistling!  Embarrassingly stupid, but clinically sound (or a non- clinical sound!)

Just a question for you (AKA the return of word of the day)…

If a man came in with a cold sore and his glands swollen in the neck would you tell him he had …

Labial Herpes and cervical lymphadenopathy?

He might think you were confused about his gender and think he had something wrong with his cervix and herpes around his labia (study the picture on this last link well boys, you might find something you haven’t before!)

Anyhow, my patient last week had herpes labial and told me it hadn’t cleared up with coleslaw cream….

Well it won’t love, that’s just for salads!

Ho -hum. Dim Sum. Coleslaw. Now that’s unusual in a health care blog!!  Better keep taking the tablets….

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Monday Moaning.

Posted on May 14, 2007. Filed under: Journal from behind the desk... |

Monday morning…. One of my early patients said on leaving: “Well that’s another one you can tick off!”

OK! So I found that a little offensive, suggesting that my clinic was just a factory line I have to work through, rather than the caring therapeutic environment it is.  So maybe he was an “in and out” patient on a busy Monday morning, but if he had something in need of my full attention he would have received it.

Instead he had some dry skin, so I suggested an emollient – well he could have tried that first if he had the initiative.  What more did he want from me – a full skin transplant perhaps?

The full skin graft was hellish…

My last patient on Monday morning came in and sat down, I introduced myself and then we looked at each other and said nothing.  So I start…

“Can I help?”

Well, don’t you know” -
OK. I’ve had people be “funny” with me before, but she was serious.

“I’m afraid not, what’s the trouble?”

“Well, I was expecting you to know…” 

Turns out she’d been seen in a diabetic clinic on Friday, and advised by her consultant her bloods were abnormal and she needed to urgently start some medication.  We, of course, had no letter, no bloods and therefore no idea what the plan was.   Patient was most despondent that we couldn’t start her treatment today. 

Hello world!! A few question: 

1: If something is urgent – then why didn’t the consultant prescribe it? – probably because he doesn’t want it to come out of his budget.

2: If the consultant felt that the GP needed to know this information urgently why didn’t he ensure it was faxed through? – he lives in an ivory tower and thinks that speaking into a Dictaphone magically makes information appear exactly where he wants it, with no idea that his secretary might type it up a week later and then send it.

Max banging his head against an Ivory tower

and finally 3: If a consultant has not ensured the urgent thing gets done urgently, why is the patient blaming me?

I usually post once a week – typically on a Friday, but if this week keeps going at this rate who knows!!

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Goodbye to baby & fat lady & hello monkey!!

Posted on May 9, 2007. Filed under: Benign |

Bizarre. I have just felt the need to delete a picture from my blog.  No it wasn’t a group of naked young foxes….

…cute!

In P=Q-D/C/BM, I used a picture of a over weight lady trying to get her jeans on, following a news article about weight gain being in the genes/jeans. Since then I have recieved loads of comments of abuse about fat people. The majority of which I have deleted.  These are not from my normal readers (I know there are a few of you out there), but from people doing google images searches.  So despite my raising blog stats, the lady has gone. Yes I want readers, but not horrid abusive ones – unless of course they are abusive to me directly!

 Back to stats… Max has now had over 13, 000 hits.  So to celebrate, I’ve decided to change my look. I played around with different themes but couldn’t find one I liked more than this, so I have got a new photo….

Sterling

A tie wearing serious looking dude -as oppose to the middle finger waving baby.

 Anyhow….how’s it going?  I’ve had a fairly normal week. Someone wanted me to look in their ears, and ever since then I’ve been itchy like I’ve got cirrhosis

Odd behaviour you might think.  ALAS NO!!! It wasn’t the patient that made me itch, it was the little critters living in her hair. Not one or two – but lots of lice. 

I told my co-workers of my psychological itching (I’m hoping it is psychological only – I don’t like to take my work home with me!!)  and they told me of a woman who keeps monkeys, and how her children used to just be de-nitted by the monkey!

So once again Max gets thinking. When I were lad – we had “the nit nurse!!” but these are a thing of the past… Apparently a “waste of resources”.  But monkeys – well you can pay them peanuts – literally!  Each GP surgery could have one in the waiting room – beats that crappy tank of fish at the dentist for entertainment while waiting to be seen.

 Poor old Nitty Nora – replaced by a monkey!

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Staff Nursitis

Posted on May 3, 2007. Filed under: Benign |

 Kim got me thinking about the treatment for student nurses, this in turn had me thinking about newly qualified staff nurses with what we called “Staff- nursitis“.  This horrid problem is an inflammation of ego shortly following graduation, and although it is self resolving problem, some cases are so acute that they need to be managed by more experienced health care workers.   Some of the best people for curing staff nursitis where the health care assistants, who could drop arrogant “but I AM the nurse” types down a peg or two quite quickly.

The treatment regeime also worked well for students suffering with “I-dont-wanna-be-here-hoea” who stand in emergency departments looking lost and not helping, counting the seconds until their placement was over.

The treatment in our emergency department was helped vastly by a nursing rotation, which meant your colleagues were scattered around the hospital just waiting to help with the treatment….

 So what am I talking about?  Well I’ve already mentioned sending someone to stores for diabetic soap, by the time they realise they’ve been stitched up due to their own naivity, the staff-nursitis is starting to wear off a little. Other classics include:

Sending your victim sufferer to pharmacy to get some Bowman’s Capsules.

OR: to the Orthopaedic wards for a “long weight” (or is that a long wait?)

OR: for the really dim ones : to gynae to get some Fallopian tubes.

A student nurse friend of mine, had a DIY store job in his “spare time” and was sent by his overalled colleagues to get a glass hammer.  So I guess this is not something exclusive to health care.

The morale of the story is…you are part of a team remember that – inflatted ego’s can soon be popped.

As promised (you thought I was joking last week!) – Word of the day: Sphygmomanometer.

Truely a brilliant word, firstly if you ignore the false vowel (“y”- (y not?)).  It has a full 6 letters before it reaches a proper vowel!

Definition: Well the “meter” bit means obviously that it measures something. So it obviously measures “sphygmomano’s”, which are the amount of Male mummies in a Sphinx. Doh!

The Great Sphinx at Giza, Egypt

In all seriousness they are so much better than the modern rubbish – but alas that Mercury is dangerous…

“I want to break free!”

That’ll do for this week – don’t forget to read  cosNOW!!!

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