Archive for August, 2007

Nagging – part two…

Posted on August 30, 2007. Filed under: Journal from behind the desk... |

Did you think I was joking about nagging going on? Did you? eh? Right then, I’ll carry on, but first, could you sit up straight please and how many times do I have to tell you to uncross your legs!?

In part one I passed a comment about health professionals nagging patients.  In the world of primary care, we have developed a concept that could be referred to as the “Reverse while I’m here”.

Traditionally it is a cringe moment, you’ve spent quality time with your patient, you know the next patient is waiting, you round up, and then the patient drops that bomb…“While I’m here could you just….”

However a change has occurred. With the introduction of QOF, the health professionals are rewarded points, which turn into money, for meeting government targets.  So it’s the government nagging primary care to make sure that all diabetics get their reviews, all hypertensives get their BP checked 6/12ly etc.

This nagging is now passed to the patient. So the roles have reversed. The patient is trying to go home, in time to pick up the kids, put dinner on, make a cuppa, but no!  The clinician is now the one saying: “While you’re here…can I just check your BP, peak flow, depression score, blood sugars, ask you to stop smoking etc. etc.”

It therefore seems nagging is contagious. The government nag us, so we nag the patient, the patient is then late home, and has to nag “someone else” to get things done on time, that “someone else” then gets extra stress, feels run down, gets a cold, goes to the surgery, tells the clinican about their cold, and then….says “While I’m here, can you give me something for the stress of living with a nagger”, then the clinician says, “while your here can we just……..”

It’s a vicious circle.

In fact it is not only a vicious circle, it is contagious and like nagging it goes on and on and on.  Actually what is the difference between going on and on and on, and something being contagious. OH MY GOD – there isn’t one, ladies and gentleman we have an epidemic!!  Hey, if we have an epidemic, then surely the government will make another QOF target to combat the epidemic, thus perpetuating the problem further, meaning we will need yet more targets to combat it and then the problem will get worse so we will need more targets and on and on and on and on and..….

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Nagging – part one….

Posted on August 23, 2007. Filed under: Benign, Journal from behind the desk... |

Part one – yes there is more than one part, well nagging always does go on a bit doesn’t it! 

Nagging! Hmmm, a controversial subject.

It’s an interesting fact that about half of all male patients who present in my room, all start the consultation with the phrase: “I wouldn’t have come but my wife nagged me to.”

Now, apparently Nagging can lower the risk of heart attacks, the suggestion from the full report is that married men who are nagged by their wives are 50% less likely to develop heart problems than those who are not nagged.  I should be blogging for another 100 years at least then.

Just let me finish my blog dear…

Interesting wording that “Married men who are nagged by their wives”. What about unmarried men who are nagged by other peoples wives? 

In my mind, the research should have looked into the effects of nagging women, on the woman’s health. I swear if my wife wasn’t able to outlet her stress on me, she would have had a stroke years ago.   (Hey, if she stopped nagging, perhaps we’d have time for more than a stroke, wink wink, nudge, nudge).

The report begs the question, is it just the act of being nagged that is good for us? Or is it more to do with what we’re being nagged about. For example:

“Don’t just sit there eating donuts, take the rubbish out, hoover, and take the dog for a walk” – exercise v’s TV, obviously the exercise induced by the nagging is good for us, rather than the actual nag.

OR

“For godsake, you’ve forgotten you pills again, I swear I’ll go mad if you don’t take them!” – taking tablets v’s not taking tablets, obviously taking the tablets is good for us, rather than the nag.

OR perhaps, it’s the run to the pub, to get away from the nagger that is keeping us healthy.

As health professionals we must be doing a good job at keeping our patients hearts healthy, nothing to do with the monitoring, prescribing, and numerous other aspects of our jobs, but more to do with the perpetual nagging…urm excuse me?….yes you reading… why have YOU got your legs crossed?

In part two I just go on some more, I mean you’ve already got the point, but will I stop? NO! Not until you really get my point, are you listening? For goodness sake, how many times must I tell you…….

I’ve just opened a new page on spooooooky goings on, it’s in its infancy, so have a read and add your comments or tales. All contributions welcome.

Also [cowgirlLetters.jpg]Change of Shift is up, with a wild west theme at MJ’s – yeeee haaaaaaw!

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Health Beliefs.

Posted on August 16, 2007. Filed under: Journal from behind the desk... |

Patients never fail to amaze me, sometimes the things they come out with seem so bizarre and obviously need addressing.  Now I’m not going to get deep into the debates about health beliefs, alternative therapy and placebo effects.  I don’t know if moonlight soaked daisy leaves have an effect on the sexual behaviour of the over 80’s, nor am I going to research it, but health beliefs still come into play with every patient we see.

I’ve been meaning to write about health beliefs for a while, but I was spurred on by a post entitled X-rated patient by May.  Now May is of tender heart, and wasn’t sure if this was funny or sad.  From her comments most people felt it was funny. I agree or else I wouldn’t have mentioned it.

Health beliefs can be varied and totally inbedded in history, or just as in May’s story, just based in a complete lack of understanding.

The ones with historical backing are the most difficult to combat and in some cases I just ignore them if they are not directly adverse to treatment.  Some I can not ignore and oddly feel quite passionate about. 

If I don’t use cotton buds my ears will wax up:

Grim!

OK this is not too funny, but bugs the hell out of me… 

I know it’s sad but true.  Impacted wax pushed down the canal but a bloody cotton bud, makes my BP go up.  The belief that this is going to help is habitual, and will envoke my 5 point lecture on why not to use them, finishing with… ” my personal favorite is it says on the box not to put into your ear canal!”

Pain killers won’t help: 

Poster Credit

Another sort of health belief that drives me potty is the patients that present with pain, but haven’t taken any pain killers.  This tends to be for one of two reasons:

“I don’t like taking tablets” : response: “you prefer the pain do you?”

“I thought it would mask the symptoms”: response: “that’s the whole bloody point!!”

Actually with the latter I can understand the logic. I do feel the need with inflammatory problems to explain that the anti-inflammatory tablets will actually help resolve the problem, “it’s like…urrrr…. in the name man!”.

I can’t get pregnant if…: 

One of the scariest areas of health belief is teenages and sexual health, there are numerous antedotes suggesting wierd and very unreliable methods of contraception…”Maria in 6th form said that if I go on top, his spunk won’t be able to stay inside, so I can’t be pregnant”. 

Then there is the otherside: paranoid teenagers. I recall a 15 year old attending for emergency contraceptive, after her boyfriend ejaculate in his underwear, while she was also wearing underwear.  Look if a grown man can’t find the hole, I don’t expect a microscopic sperm is going to have much luck navigating it’s way between two pairs of undies, then find it’s way to the vagina and still have the strength to swim any further!  Although you do start to doubt yourself from time to time.

But my child will look like Arnie….

One for the asthma nurses. There are multiple challenges trying to get asthmatics to use their medication to give them maximum therapeutic value. One barrier is parents belief that steroids (short course oral or long term inhaled) will leave their child muscle bound. Firstly it just isn’t going to have that effect, and secondly I’d rather have increased muscle growth than acute respiratory difficulty.

These are merely the common ones. It’s the occasional sporadic ones that make me giggle.  So be on the look out for them and let me know…

I am a member of the NPUK nursing forum, and one of the regulars just mentioned:

A 92 year old lady who heard that a lot of people die at 3a.m. so she sets her alarm for ten to 3 to take a couple of swigs of brandy to ‘keep her heart racing ‘ till morning!!!!!! Great logic!  Thanks for that one Dee – hope you don’t mind me poaching it.

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On my 18th I got a suitcase…

Posted on August 9, 2007. Filed under: Journal from behind the desk... |

“Happy 18th Birthday son….we bought you a suitcase!”

OK my hair wasn’t quite that retro

I was happy with that. I was off to get drunk and train to be a nurse! Cool!

I mention this because it seems there is a growing population who seem reluctant to untie the apron strings of momma’s food and love!

When I was in my mid to later teens I wouldn’t have dreamed of bringing my mum into the doctors with me, but some do. This week however I have been a little shocked. 

Firstly it was a 20 year old female, who sat quietly while her mummy told me all about her daughters poorly throat. Bless.  I didn’t mind too much, I thought perhaps she had laryngitis and couldn’t talk very well. I felt quite embarrassed when I asked:

“Are you having trouble talking?”

and the 20 year old, clear as a fog horn said:

“NO!”

I felt like advising they went home a had some Calpol, rather than a nasty adult tablet of Paracetamol. (AKA Acetaminophen – come on Americans speak English!! – look I love ya really – oddly most of my readers are American (it must be my swell accent!), so I best not take the pee too much!) – oooh side tracked!

But then it just got worse…

A guy in his mid 20’s came in complaining of a itchy peri-anal rash (as oppose to perennial rash – which would of course be an abundance of colourful flowers – some of my readers are gardeners!) Sorry! side tracked again.  (and oppose to a perineal rash – some of my readers are nurses!) Whoa - easily distracted today.

Anyway, there he stood, bum in my face. I advised I thought it was a fungal infection – and he said….

“That’s what my mum thought when she saw it”

Eeeewwww!

Purhaps this is more a reflection of my relationship with my mum, but there is no way I’d show her my butt rash!

OK so I have no problem really with patients of any age, bringing in a any friend or any relative for support, but from time to time, I just think….WHY?

All done – well pack your suitcase and head over to Kim’s for the new logo’d change of shift.

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Max is listening…

Posted on August 2, 2007. Filed under: Journal from behind the desk... |

One of those complicated weeks.  When listening to what the patient says and interpreting what the patient means is important – these two things however may not be the same…

I’m all ears!

On the patients notes is the name of nearly ever clinican in the building, all have prescribed various treatments for constipation and yet the patient is still constipated.  Also within those notes, is very little writing. Alas I like typing note – fearful of getting a complaint.

Alas my collegues don’t!

Next to me is a elderly patient with a long history of unsolvable constipation.

Moments later that patient is laying on the bed. Bowel sounds normal, abdo soft, non specific tenderness. Unable to feel much in the way of descending colon.  Percussion light and bouncy – AKA – not constipated.

“Yes, I am sonny!”

Bordering on frustration, Max takes a step back, breathes in and asks a simple question.  “What are your symptoms?”

Pt: “I get constipated, I  only have rabbit droppings”

I wondered where they’d gone!

Max: “How often do you sit on the toilet and try to pass a motion?”

Pt: “7-8 times a day, but I never pass much”

Max: “…but everytime you go you pass a little?”

Pt: “yes, that’s because I’m constipated”

Max (try not to scream – no you’re not bloody constipated): “Apart from your rabbit droppings, what are your symptoms?”

(Next time someone says they’ve got a BSC – ask if they mean a Bristol Stool Chart!)

Pt: (apparently trying not to get frustrated by my perpetual questioning): “I get bloated”.

Max thinks…looks in the formulary, looks at patients medication. Thinks. Pt is on a PPI for some heartburn experienced several months ago. This was put on repeat, since taking it the patient has had flatulence and abdo pains.  This is a side effect of PPI’s.

Max confirms the patient hasn’t had heartburn since taking the tablets, (one month is often enough).  Stops the PPI and tries to convince the patient they are not constipated.

I know my patient is not convinced. Fingers crossed.  I try to explain that if I tried to poo 7-8 times a day I would only have rabbit droppings.  Not convinced – but hopefully the PPI is causing the symptoms, and stopping it will resolve them.

I would love to know if anyone has found this patient clinically constipated, but nobody has written enough in the notes!

Hey hoe!

Additionally I have a patient whom I referred for counselling, but he didn’t go – thought it wouldn’t help.  Keeps coming back to see me and spends 30 minutes telling me his problems, and then says he feels better afterwards. I’m sure the feeling of unburdening his problems, is actually counselling, but not with a trained counsellor. (That’ll be my next course then!)  His problems are probably exacerbated by spending 30 minutes talking to me, and then getting the crap beaten out of him in the waiting room by all my patients that have had to wait while he has off loaded!

 Hay Hoe again!

The sorting hat says that I belong in Gryffindor!

Said Gryffindor, “We’ll teach all those with brave deeds to their name.”

Students of Gryffindor are typically brave, daring, and chivalrous.
Famous members include Harry, Ron, Hermione, Albus Dumbledore (head of Hogwarts), and Minerva McGonagall (head of Gryffindor).

Take the most scientific Harry Potter
Quiz
ever created.

Get Sorted Now!

Thanks to Mousie for that one!

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