Archive for June, 2008

What clinicians say and what they really mean…

Posted on June 18, 2008. Filed under: Benign |

After identifying what patients say and what they really mean, I suppose it is only fair to identify that it isn’t just the patient who says one thing, but means another….the clinician is equally as problematic.

Classically and easily recognised is the nurse aiming a needle at a juicy buttock whilst muttering the reassuring phrase: “This won’t hurt a bit” - meaning “This’ll hurt a lot!”

 Bend over…Just a small prick?

In other case it is simply an issue that the patients definition in real life is different to the clinicians. The best example of this is the terms “acute” and “chronic”. “Acute” in the patients mind translates directly into “serious.”

To clarify – “Acute” to a patient means: “Holy carp! I’m going to die soon”.

Whereas to a clinician it means: “You’ve come to see me about something that you’ve only had since this morning!”

On the other hand to a patient “chronic” means “I’m riddled with this thing and it’s going to slowly kill me!”

Whereas the clinician see “chronic” as: “You’ve had it for so long why have you decided to come and show me late on a Friday evening?”

So what else falls from the mouth of the clinician that needs interpretation…

“Hmmm, very interesting, I think we need to run a few test”

Means: “I’m sorry I haven’t a bloody clue what is wrong with you”

 or : “You’ve come in here with nothing wrong, and wasted every-ones time, consequently I shall punish you by making you have lots of uncomfortable procedures, hahahahahahahahahahahahaha!”

“If you’ve any concerns, come straight back and let me know!”

Means: “Don’t sue me, I’ve told you to come back if it all goes terribly wrong, so if you face swells to the size of a meteorite and implodes, it’s your fault for not coming back like I told you to”

“Hang on…I’ll be with you in a minute..”

means: “I’ve got something more important to do, you can get seen quicker if you become more ill than the person I’m currently spending all my time with; a cardiac arrest should do it, but the poor positioning of your pillow really doesn’t get a priority right now”.

or: “I’ll sort you out before you breach the governments latest targets.”

or: “I’ll sort you out before the government targets change yet again.”

There should be a bed on the ward for you any moment

means: “Someone on the ward has just had a cardiac arrest”

Just emptying a bed for you now sir…

 or: “The ward staff are just about to come off their coffee break”

There’s nothing to worry about…

means: “I’ve seen this done once or twice, so I’m sure I can do it”.

or:  “You death is imminent – why waste those last moments worrying about it?”

You might want to look the other way:

means: “I don’t want you to see how much my hands are shaking.”

or as I like to say to my patient… “You might want to look the other way, I know I’m going to…”  Mind you I also tend to answer quicker than the patient when the patients relative say’s “Do you want to hold my hand?”  with a speedy “Thanks, but I’ll just do this first”.  I am so professional.

Hmm, anyway where was I…oh yeah….

There’s no need to be embarrassed

means: I’m going to laugh when you’ve gone, then tell everyone in the office and then write about it on my blog….”

…not me of course, I wouldn’t do that…

…would I???

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What patients say and what they really mean!

Posted on June 11, 2008. Filed under: Benign |

From the start of the consultation right up until the very last seconds, patients have a new language with definitions that are different from those used in the rest of their lives.  It is the clinicians responsibility to recognise these key phrases and translate them.  Below I have started a quick guide, please feel free to add in the comments box any additions.  As the Doctor said to the man with a lettuce up his bottom: “I am sure this is just the tip of the iceberg”…

I wouldn’t have normally come

Meaning either:

“I always come, but I like to make excuses”

“My spouse said I’d get a divorce if I didn’t get it sorted”

“I have problems with premature ejaculation” (Literal translation!)

 

“I don’t like to bother you!”

Meaning:

“I couldn’t get an appointment to see anyone else”

“I usual limit my visits to once every other day”

“I am dying”

 

“I don’t like taking tablets/drugs!”

Meaning:

“I want a quick fix and I haven’t bothered to do anything myself that might help, as I lack common sense”

“I don’t like buying tablets – I get free prescriptions!”

“I like the pain and I’ve just come here today to brag about how tough I am”

 

Thanks and bye, oh by the way…

Meaning:

“I know you’ve just spent all you consultation time looking at a tiny patch of dry skin that I pretended to be worried about, but I really have crushing chest pain/penile rash/vaginal discharge/deep psychological problems that I am now going to share with you and expect you to treat, meaning that every other patient in the waiting room is going to have to read 20 year old magazines while waiting for you to finish with me”.

 

“I’m sure it’s nothing serious but…”

This is slightly more tricky…it could mean…

“I’m dying aren’t I? It’s meningitis with secondary cancer and a heart attack all at the same time, how long have I got to live? Oh my god I think I’ve just had a stroke!”

However essentially when a patient says the words “I feel pretty well really” or “I feel really unwell” the reverse is invariablethe clinical true. For example:

“I feel pretty well really, I’ve just got crushing chest pain, radiating down my left arm and shortness of breath, oh and by the way I feel clammy and sick”

or

“I feel really unwell, I’ve got one asymptomatic spot on my hand which has been there all morning and I’m otherwise completely well….am I going to die?”

Time is also something difficult to define:

“I’ve had it ages” can mean anything from; “it started well over an hour ago” to “oooh, about 50 years”

and

“I’ve not had it for long can mean anything from: “oooh, it started less than 50 years ago” to “It started about an hour ago”.

In general terms understanding what the patient says is more about cross examining and pinning them to a definite answer rather than taking what they say on face value.

Fingers crossed for some more examples please…I look forward to reading them…

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Smoking clashes!

Posted on June 5, 2008. Filed under: Apply topically | Tags: |

In the last week news broke about something that happened in 1956….Surely that is an oxymoron.

Oxymoron – a moron who breathes oxygen! (Incidentally does undefinable have a definition??)

On the subjects of Moron’s more about this old news which is new, yet old…  In 1956 Harold Macmillan (who later became Prime minister), and the cabinet were given information identifying the health risks of smoking… Macmillan however was worried about the effects the warning might have on the UK government’s tax revenues!!!!  So health risks were down played!

Money verses Health??

This clashes with a government report published this week which states that “Smoking related disease kills 87,000 people a year, the equivalent to the entire population of a major city such as Durham.”  Smoking is the biggest killer in England.  Don’t even ask how much health spending could have been saved if the health risks were identified by Macmillan earlier, or perhaps it still works out more profitable to tax people for smoking and pay the NHS to deal with the effects!

Also in the report we learn that more than 200,000 children and teenagers under the age of 16 take up smoking every year, well surely the government doesn’t want to stop this practice. I mean it is difficult to get under 16′s to pay tax on anything else…(except alcohol of course – don’t get me started on that one.)

But apparently the government report does want to cut the amount of teen smokers by….and I love this bit… increased pack sizes!!! 

Get that in you handbag without mum spotting it!

Actually the theory is that larger pack sizes might prevent teenagers being able to afford them.  WAIT!!! These are teenagers we are talking about. The second most efficient money grabbing parasites on the planet, second only to the Tax man himself.  “A fiver from mum, a fiver from dad, a fiver from granny, and £10 from step dad so he looks better than dad, sell little brothers ipod on Ebay, and choose five friends to share a packet of ciggies with and we’ve got enough cigarettes for the month and change for some cider too!”

If there is more cigarettes in a packet, this surely means that the teenager has to go to the shop less, thus decreasing the chances of getting caught!

Come on that’s a rubbish idea…any others???

Well actually yes…

Oh go on then…

Vending machines that require proof of age might help prevent young people starting to smoke, according to the new government proposals.

Give me a break…it’s a machine, teenager can fool the average shop keeper, I’m not sure how Robo-shop is going to police it any better, but I’ll give you the benefit of the doubt and wait to see the technology before I criticise it, and other ideas….

Ooooh, oooooh, I’ve got one…how about removing branding and logos from tobacco packaging, well Public Health minister Dawn Primarolo said: “If banning brightly coloured packets…helps save lives, then that is what we should do”.

Do you want a cigarette???

 Yeah, but no, but yeah. The box is like so dull and it clashes wiv me top, but the craving is driving me mad…No actually I’m gonna quit, coz the box is like well dull.

Hmmm, not convinced by that strategy either.

Anyway I’ve got to go now, I have to read my guide on when I can let my three year old start drinking.

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