Archive for July, 2008

Only half the story…

Posted on July 30, 2008. Filed under: At home..., Benign |

I sit in my room, and simple things bother me…I see patients with simple conditions that just won’t respond to the treatment that works for everyone else…something is missing…

Have you ever considered the concept that every member of your family is someones patient?!

It’s quite a scary thought when you consider how things are from the other side of the consulting room desk.  Last night I was on the phone to my grandparents – thankfully not registered at the surgery where I work.  We were (as usual) chatting about all there usual health problems and it became apparent that the clinician only really gets… half the story or less…
I doubt my Grandad’s Doctor understands why this fairly healthy chap in his 80′s had so many problems with his knee after he had it replaced. But then I doubt my Grandad’s Doctor knows that as well as having physiotherapy, my Grandma told Grandad that a 2 mile walk would be the best thing to for him on the second week after his surgery. I also doubt that he knows Grandad has been up the ladder on a grass slope leaning over to cut the hedges, so that the gardener wouldn’t have to worry about it.

I also doubt the Doctor can understand why Grandad has had such terrible back pain since his knee op.  If he knew that Grandad throws a rope over the balcony for Grandma to hook the shopping on and then he heaves it back up, the Doctor might understand a bit better…well at least his resting his knee rather than running up the stairs with the shopping!

Joy-bells, Joy-bells, where for art thou shopping bags?

Then I hear about all my Grandma’s troubles.

She’s one of these ladies with otitis externa that just doesn’t want to resolve.  I see patients like this all the time… I can’t figure out why it won’t clear up…  But I know why my Grandma’s doesn’t… my Grandad won’t let her leave her hearing aid out, so her canal never dries up and stays permanently as wet as the men’s toilet at the footy ground, with an odour to match (nice).  My Grandad understands about ear canals, that’s why he uses his car keys to get the wax out of them…apparently it helps the ignition as well!! (NOT RECOMMENDED!!!!)

Brrrrrm, Brrrrrrm. Listen to that engine turn over…

During the phone call I had to laugh out loud..nobody heard me, so nobody was offended….

Granny Max: I had to have the gunk syringed out of my ears again today.

Max (cynically): Did that make it better or worse?

Granny Max: Yes, I saw the nurse!!

So as a clinician am I any better…. Well I personally am not a good patient.  My doctor is fabulous, his young, enthusiastic and enjoys educating his patients.  I am the ultimate patient with an agenda…I hate patients that come in and say…”This is what I want”…but I am that patient.

By the time I am actually ill enough to be bothered to go to the doctor, I have diagnosed myself and just want the required treatment.  I don’t want him to draw me a picture, I understand the mechanism of the problem, I know the best home-care remedies, I have tried them and am happy to continue to do so…I don’t go to the doctors for assessment…”Give me what I want and then go and make yourself a coffee in the rest of my appointment time…please!” 

 How cross would I make me?  Very!!  So I try my best to humour him, but I know I’m wasting his time…and that’s what bugs me most.

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and now for the news…

Posted on July 24, 2008. Filed under: Apply topically |

As I was doing my occasional trawl through the medical news…

  I found this article about a new treatment patch to immunise against and decrease the duration of travellers diarrhoea caused by that retched E. Coli. 

So basically…it’s an adhesive patch that can reduce or prevent diarrhoea…  Sounds a bit like putting a plaster on a oozing wound….  Now you know I’m only joking, a patch to prevent e-coli is great and yes I really do understand that it isn’t a constipating adhesive!  But patch therapy of any kind makes me a tad nervous.

HRT patches for example…I have visions of a menopausal woman, using patches successfully and then suddenly starting to get flushes again.  The next thing she knows her husband is getting a bit stroppy and moaning that women “just don’t understand what it’s like for a man”.  Only to realise that her patch is stuck to his butt!

…and as for those nicotine patches – I just can’t get them to light!

Also in my trawl through I found this dumb ass article…

Researchers found that adolescents who made pledges to remain virgins until they are married were less likely to be sexually active over the three-year study period than other youth who were similar to them, but who did not make a virginity pledge, according to the study published on-line by the Journal of Adolescent Health.

OK. Let’s take this nice a slow…Someone did research, that basically says…people that vow not to have sex, don’t have sex…in comparison with those that don’t vow not to have sex….   This is a bit like researching whether monks have less sex that prostitutes!!

“Friar Tuck” or “Try a ….”

Will their next research project assess whether smokers smoke more than non smokers!?!

…And finally more useful research…Soya may be harming fertility…so bearing in mind that the Chinesse have a soya rich diet, how come they have the biggest and fastest increasing population on the planet?  Just a thought.

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Just Kiddin’

Posted on July 17, 2008. Filed under: Uncategorized |

I’ve been too busy to blog this week…apologies. But just to give you a little humour, I’ve got a case history for you…

An Irish woman presented to ask about reviving her husband’s libido.

Max: ‘What about trying Viagra?’

Patients wife: ‘Not a chance, he won’t even take an aspirin.’

Max: ‘Not a problem, give him an ‘Irish Viagra’. Drop the Viagra tablet into his coffee. He won’t even taste it.  Give it a try and call me in a week to let me know how things went.’

It wasn’t a week later when she called back and Max directly inquired as
to her progress.

Patient’s wife exclaimed, ‘Oh, faith, bejaysus and begorrah! T’was horrid! Just terrible. I did as you advised and slipped it in his coffee and the effect was almost immediate.

He jumped straight up, with a twinkle in his eye and with
his pants a-bulging fiercely! With one swoop of his arm, he sent me cups
and tablecloth flying, ripped me clothes to tatters and took me then and
there passionately on the tabletop! It was a nightmare, I tell you, an
absolute nightmare!’

Max ‘Why so terrible, Did you mean the sex your husband provided wasn’t good?’

Patients wife: ‘Twas the best sex I’ve had in 25 years! But sure as I’m
sittin’ here, I’ll never be able to show me face in Starbucks again!’

Just Kiddin!!

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Mechanism of Injury…

Posted on July 10, 2008. Filed under: Benign, Foreign Bodies |

The mechanism of injury is an important part of history taking when finding out about an injured patient.  You can tell a lot about the injury when you can visualise what actually happened.

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If a patient states “I had a car crash”, the mechanism of injury allows us to find out speed, airbag activation, seat belt impact, position in vehicle, direction of impact et cetera, et cetera and take into account the clinical implications. Often it is fairly mundane stuff: “I slipped on the bottom step and my foot went inward” – OK so I know before I examine which ligaments are likely to be sore and which less so.  But sometimes it can be a little more wacky!!

Here is my chance to vent some of my favourites…and yes groovers these are all straight from my patients mouth, please feel free to add your own…although there are plenty of urban legends out there (some involving being naked while using vacuum cleaners).

Curious design for a ride on vacuum!

Busy Night shift in the Emergency Department…

A young lady presents with atypical lacerations to her back. She is embarrassed and not giving the doctors a good history. So I change my name to “Frank” and bluntly ask her what actually happened, because… “what your telling us doesn’t fit the injury”.  

It turns out she and her boyfriend were in bed, they had a glass of wine which she’d place on the floor. They were (hmm… how shall I phrase this without getting an adult rating…ok…) pretending to be dogs, when he decided to step things up a notch(….hmm too cryptic), shove it in a different orifice (that should do!).  She (understandably in my mind) objected and turned round sharply to get him off...(hmmm, that needs rephrasing too!!) tell him she wasn’t happy about his decision making.

Consequently she lost her balance and fell off the bed, landing on top of the wine glass, which obviously broke and subsequently caused the laceration.  She  ended up with several pricks in her back when we sutured her up, so a no win situation for her.

Next…

2 adult males presenting with rope burns to the neck.  This story is summarised as it all got a bit “Jerry Springer”:

 Basically to male friends had found out that one woman was seeing both of them…clear so far.   They were upset, they had both been lied to, they decided to commit suicide together.  (Nutty). They had one piece of rope and tied a noose in both ends, and climbed onto a big tree branch. The plan was they’d jump together (off opposite sides of the branch obviously) and hang together to teach her a lesson!!! (Don’t go out with nutters..perhaps?)

So there they are in the department with rope burns, but not broken necks…something else broke….that’s right….the branch snapped!

It all ended happily when the girl came to the department and she decided what to do.  They left a threesome!!

   I doubt they got married though!

As I right this I realise how absolutely absurd this sounds. I’m not sure I would believe me…but it’s true!

Next…

Kid with saucepan on his head…a stereotypical presentation. But I’ve only seen it once. Mechanism of Injury….Dad put it on his “Little solider!” Can’t even blame the kid!

So remember if you are going to do something stupid, and you might get injured, be prepared to share you idiocy with the emergency department staff, they won’t laugh…(in your face).

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NHS 60th Birthday…

Posted on July 2, 2008. Filed under: Apply topically, Elsewhere in the blogisphere |

OK it’s a one off. When I started writing this it was going to be a giggle.  Comparing the 60 year old NHS to any other 60 year old.  But I apologise it became a bit of a soap box…SORRY!!!

Am I being Bold??

Imagine it’s 1948…and you’re reading the Lancet (no not online you numpty!!)

And there is Aneurin Bevan. The Lancet, 1948 :

On 5 July we start together, the new National Health Service. It has not had an altogether trouble-free gestation. (Start as you mean to go on)  There have been understandable anxieties, inevitable in so great and novel an undertaking (“Undertaking” – done by an Undertaker??? – Not sure that should be mentioned in the introduction to a health service!!) Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others (One day we’ll have enough staff…right!?!?!?!)  and of modern replanned buildings and equipment. But the sooner we start, the sooner we can try to see these things and to secure the improvements we all want. My job is to give you all the facilities, resources and help I can, and then to leave you alone as professional men and women to use your skills and judgement without hindrance. Let us try to develop that partnership from now on.’

6O years on and Gordon Brown is now just considering making things clinican led again, having just filled the last decade with government targets, QOF and the like!

At 60 I’ll have spent many years working, trying to meet various targets, follow guidelines and learning everything I need to do my job (I might actually know what I’m doing by the time I retire!). At 60 can we please let the NHS be the same.  Let her retire from the task driven government target led work place and enjoy an independent old age, doing what she knows about best, looking after patient and caring for their actual needs rather than hoop jumping, tick box assessments that simply make the government look good staistically, but don’t really give quality to patient care.

Wow! I feel better for that.  It’s like have a big bowel movement and getting a load of crap out!  (Not dissimilar to this blog in general (thought I’d say what you were thinking!. I’m big enough to take criticism.  I’m tough, I don’t just smell strong!))

HAPPY BIRTHDAY NHS!!!!  Sometimes it all seems a bit bleak, the politicians stick there oar in, the media moan about it, and grumpy patients send letters to the papers (those content rarely do).  But 24hours a day, 7 days a week, come hell or high water, there she is ready at a split seconds notice to save lives, make people more comfortable, manage everything from slight aches to chronic agony, bring babies safely into the world and much more besides.  She’s not a machine, she is about 970,000 people, including 33,647 consultants and 376,767 nurses and midwives.  Bringing in life and giving dignity to those ending.   So I say “HAPPY BIRTHDAY” and a big thank you to her.  I say that as someone who has experience on both sides,  as someone who has experienced extremely difficult times from the public side and felt the support and professionalism of the NHS.  Here’s to the next 60.

Cheers.

 

Elsewhere sad news: She may not be 60 but ER Nursey has decided it is time to Blog retire, obviously she shall be missed.  Good luck and I hope the withdrawal isn’t too severe.

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